Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A79979 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | A79979 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | A79979 | CA |
N | 207RG0300X | Geriatric Medicine | A79979 | CA |
Y | 208D00000X | General Practice Physician | A79979 | CA |
NPI | 1164692703 |
---|---|
Provider Name | Heriberto Nunez |
First Address | Monterey Park, CA 91754-6707 |
Second Address | Monterey Park, CA 91754-6707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2008 |
Last Update Date | 04/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A79979 | MEDICAL LICENSE (01) | CA |