Provider Demographics
NPI:1528698198
Name:NUNEZ, JELIZA CARMEN (COTA/L)
Entity type:Individual
Prefix:
First Name:JELIZA
Middle Name:CARMEN
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 UNDERCLIFF AVE APT LC
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7106
Mailing Address - Country:US
Mailing Address - Phone:929-236-8624
Mailing Address - Fax:
Practice Address - Street 1:1655 UNDERCLIFF AVE APT LC
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7106
Practice Address - Country:US
Practice Address - Phone:929-236-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009223224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant