Basic Information
| Provider Information | |||||||||
| NPI: | 1689693509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NUNEZ | ||||||||
| FirstName: | LYDIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 NW 12TH AVE STE 810 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055856649 | ||||||||
| FaxNumber: | 3055855259 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 BISCAYNE BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331379800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864668490 | ||||||||
| FaxNumber: | 3055736562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 11/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME68095 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.