Provider Demographics
NPI:1366620015
Name:FERNANDO J NUNEZ
Entity type:Organization
Organization Name:FERNANDO J NUNEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:562-862-4711
Mailing Address - Street 1:9102 FIRESTONE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5348
Mailing Address - Country:US
Mailing Address - Phone:562-862-4711
Mailing Address - Fax:562-862-4711
Practice Address - Street 1:9102 FIRESTONE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5348
Practice Address - Country:US
Practice Address - Phone:562-862-4711
Practice Address - Fax:562-862-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1049610001Medicare NSC