Basic Information
| Provider Information | |||||||||
| NPI: | 1366471864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NUNEZ | ||||||||
| FirstName: | HERNALDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12493 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331012493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055854249 | ||||||||
| FaxNumber: | 3053552242 | ||||||||
| Practice Location | |||||||||
| Address1: | 16555 NW 25TH AVE | ||||||||
| Address2: | |||||||||
| City: | OPA LOCKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330546583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864661732 | ||||||||
| FaxNumber: | 7864661670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0065728 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BN4054526 | 01 | FL | DEA | OTHER |