Provider Demographics
NPI:1396872537
Name:NUNEZ, DIANA PEREZ (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:PEREZ
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15012 MINNEHAHA ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2521
Mailing Address - Country:US
Mailing Address - Phone:818-687-0317
Mailing Address - Fax:
Practice Address - Street 1:12756 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1626
Practice Address - Country:US
Practice Address - Phone:818-896-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4212363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA305946OtherNURSE PRACTITIONER LICENS