Healthcare Provider Details

I. General information

NPI: 1255467791
Provider Name (Legal Business Name): MYLA JUNE DUNNE OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 OAKDALE RD SUITE 301
MODESTO CA
95355-3381
US

IV. Provider business mailing address

1501 OAKDALE RD SUITE 301
MODESTO CA
95355-3381
US

V. Phone/Fax

Practice location:
  • Phone: 209-571-5071
  • Fax: 209-577-1157
Mailing address:
  • Phone: 209-571-5071
  • Fax: 209-577-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number87-0536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: