Provider Demographics
NPI:1548665953
Name:NUNEZ DE PEREZ, LETICIA NICOLLE (MD)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:NICOLLE
Last Name:NUNEZ DE PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:NICOLLE
Other - Last Name:NUNEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 778912
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-8912
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-948-2700
Practice Address - Fax:317-948-2959
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076324A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics