Provider Demographics
NPI:1619194644
Name:NUNEZ, ERNESTO
Entity type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2603
Mailing Address - Country:US
Mailing Address - Phone:213-382-4400
Mailing Address - Fax:213-382-4494
Practice Address - Street 1:3600 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2603
Practice Address - Country:US
Practice Address - Phone:213-382-4400
Practice Address - Fax:213-382-4494
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01605808Medicare UPIN