Healthcare Provider Details

I. General information

NPI: 1285857896
Provider Name (Legal Business Name): MAN Y PUN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/23/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR STE 460
LA MESA CA
91942-7001
US

IV. Provider business mailing address

8860 CENTER DR STE 460
LA MESA CA
91942-7001
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-3773
  • Fax:
Mailing address:
  • Phone: 619-463-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number59205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: