Provider Demographics
NPI:1649275249
Name:NUNEZ, MARLYNN (MD)
Entity type:Individual
Prefix:
First Name:MARLYNN
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4671 S CONGRESS AVE
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4783
Mailing Address - Country:US
Mailing Address - Phone:561-434-0111
Mailing Address - Fax:561-296-3533
Practice Address - Street 1:4671 S CONGRESS AVE
Practice Address - Street 2:SUITE 100B
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4783
Practice Address - Country:US
Practice Address - Phone:561-434-0111
Practice Address - Fax:561-296-3533
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004012768207V00000X
FLME96197207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78195OtherBCBS
FL276032100Medicaid
MOH95839Medicare UPIN
MO928613296Medicare PIN