Healthcare Provider Details

I. General information

NPI: 1366447229
Provider Name (Legal Business Name): JANET B PIERUCCI PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 ENCINA RD STE A
GOLETA CA
93117-2270
US

IV. Provider business mailing address

146 SAN JOSE CT
SAN LUIS OBISPO CA
93405-1532
US

V. Phone/Fax

Practice location:
  • Phone: 805-845-8989
  • Fax: 805-544-0863
Mailing address:
  • Phone: 805-845-8989
  • Fax: 805-544-0863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: