Provider Demographics
NPI:1609766229
Name:NUNEZ, ENRIQUE JOSE
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:JOSE
Last Name:NUNEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 BOUNTIFUL AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2518
Mailing Address - Country:US
Mailing Address - Phone:509-938-8537
Mailing Address - Fax:
Practice Address - Street 1:500 S 336TH ST STE 102
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6389
Practice Address - Country:US
Practice Address - Phone:509-938-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist