Healthcare Provider Details

I. General information

NPI: 1427989722
Provider Name (Legal Business Name): PIRAT PULPUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12759 COHASSET ST
N HOLLYWOOD CA
91605-2025
US

IV. Provider business mailing address

12759 COHASSET ST
N HOLLYWOOD CA
91605-2025
US

V. Phone/Fax

Practice location:
  • Phone: 626-673-6706
  • Fax:
Mailing address:
  • Phone: 626-673-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number64414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: