Provider Demographics
NPI:1023449360
Name:NUNEZ, JISSELA
Entity type:Individual
Prefix:MRS
First Name:JISSELA
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BARRIO SABANA CARR 921 K 0H 5
Mailing Address - Street 2:HC 01 BOX 6759
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00771
Mailing Address - Country:UM
Mailing Address - Phone:787-214-2917
Mailing Address - Fax:787-712-1790
Practice Address - Street 1:CALLE SANTIAGO NUM 65 NORTE
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00778
Practice Address - Country:UM
Practice Address - Phone:787-712-1780
Practice Address - Fax:787-712-1790
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9275183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician