Provider Demographics
NPI:1427646116
Name:NUNEZ, NELSON (PA)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1364
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-1364
Mailing Address - Country:US
Mailing Address - Phone:323-564-5579
Mailing Address - Fax:
Practice Address - Street 1:200 WESTPARK WAY
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3963
Practice Address - Country:US
Practice Address - Phone:817-488-8998
Practice Address - Fax:855-295-2686
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA192772084P0800X, 363A00000X
CA60737207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology