Provider Demographics
NPI: | 1992276182 |
---|---|
Name: | NUNEZ, GUADALUPE CARINA |
Entity type: | Individual |
Prefix: | |
First Name: | GUADALUPE |
Middle Name: | CARINA |
Last Name: | NUNEZ |
Suffix: | |
Gender: | |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 17800 WOODRUFF AVE STE A |
Mailing Address - Street 2: | |
Mailing Address - City: | BELLFLOWER |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90706-7080 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 17800 WOODRUFF AVE STE A |
Practice Address - Street 2: | |
Practice Address - City: | BELLFLOWER |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90706-7080 |
Practice Address - Country: | US |
Practice Address - Phone: | 562-866-8956 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-12-16 |
Last Update Date: | 2025-05-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YM0800X, 172V00000X, 373H00000X | ||
CA | 106S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 373H00000X | Nursing Service Related Providers | Day Training/Habilitation Specialist | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | |
No | 172V00000X | Other Service Providers | Community Health Worker |