Provider Demographics
NPI:1306873799
Name:NUNEZ, RUDY (CP)
Entity type:Individual
Prefix:MR
First Name:RUDY
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 S ANAHEIM BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6218
Mailing Address - Country:US
Mailing Address - Phone:714-635-1401
Mailing Address - Fax:714-635-1422
Practice Address - Street 1:1550 S ANAHEIM BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6218
Practice Address - Country:US
Practice Address - Phone:714-635-1401
Practice Address - Fax:714-635-1422
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0007611Medicaid
CA0218090001Medicare NSC