Provider Demographics
NPI:1861785859
Name:NUNEZ, SANDRA (MFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 EXECUTIVE SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1476
Mailing Address - Country:US
Mailing Address - Phone:619-481-1725
Mailing Address - Fax:619-860-1285
Practice Address - Street 1:4275 EXECUTIVE SQ STE 200
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1476
Practice Address - Country:US
Practice Address - Phone:619-481-1725
Practice Address - Fax:619-860-1285
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 63684106H00000X
CALMFT 84299106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W416Medicare PIN