Provider Demographics
NPI:1679958649
Name:NUNN, LOLITA
Entity type:Individual
Prefix:
First Name:LOLITA
Middle Name:
Last Name:NUNN
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 1:321 COVE CT
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-4625
Mailing Address - Country:US
Mailing Address - Phone:510-689-8156
Mailing Address - Fax:510-878-9965
Practice Address - Street 1:321 COVE CT
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-4625
Practice Address - Country:US
Practice Address - Phone:510-689-8156
Practice Address - Fax:510-878-9965
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program