Provider Demographics
NPI:1396436739
Name:NUNEZ, NOAH M
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:M
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 WEST RD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:90631-8632
Mailing Address - Country:US
Mailing Address - Phone:626-222-9137
Mailing Address - Fax:
Practice Address - Street 1:875 PERIMERTER DR
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83844-0001
Practice Address - Country:US
Practice Address - Phone:208-855-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program