Healthcare Provider Details

I. General information

NPI: 1063817716
Provider Name (Legal Business Name): JOEWEL PASCUAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY
BERKELEY CA
94720-4301
US

IV. Provider business mailing address

37656 MOSSWOOD DR
FREMONT CA
94536-6639
US

V. Phone/Fax

Practice location:
  • Phone: 510-643-5808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number40817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: