Healthcare Provider Details

I. General information

NPI: 1134212160
Provider Name (Legal Business Name): PUNEH BAHA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PUNEH IRANPOUR O.D.

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 CITRACADO PKWY STE 301
ESCONDIDO CA
92029-4113
US

IV. Provider business mailing address

1955 CITRACADO PKWY STE 301
ESCONDIDO CA
92029-4113
US

V. Phone/Fax

Practice location:
  • Phone: 760-746-3934
  • Fax: 760-746-3991
Mailing address:
  • Phone: 760-746-3937
  • Fax: 760-746-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11596T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: