Healthcare Provider Details

I. General information

NPI: 1831093848
Provider Name (Legal Business Name): JOHN MICHAEL PUALENGCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 DIAMANTE WAY
OAKLEY CA
94561-6027
US

IV. Provider business mailing address

816 DIAMANTE WAY
OAKLEY CA
94561-6027
US

V. Phone/Fax

Practice location:
  • Phone: 650-201-5879
  • Fax:
Mailing address:
  • Phone: 650-201-5879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95177903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: