Basic Information
| Provider Information | |||||||||
| NPI: | 1881348027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NUNEZ | ||||||||
| FirstName: | ANDRES | ||||||||
| MiddleName: | JAMIL | ||||||||
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| Credential: | BT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 TOWN CENTER BLVD APT 4304 | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347144445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086442714 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8390 CHAMPIONS GATE BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | CHAMPIONS GATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338968311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077430723 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2022 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.