Healthcare Provider Details

I. General information

NPI: 1679990618
Provider Name (Legal Business Name): LORELEI PUNSALAN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 28TH ST
BAKERSFIELD CA
93301-1902
US

IV. Provider business mailing address

1705 28TH ST
BAKERSFIELD CA
93301-1902
US

V. Phone/Fax

Practice location:
  • Phone: 661-322-3008
  • Fax: 661-322-5507
Mailing address:
  • Phone: 661-322-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95000561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95000561
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number95000561
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95000561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: