Healthcare Provider Details

I. General information

NPI: 1316640659
Provider Name (Legal Business Name): CARMENCITA BUNGAY LABISTRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARMENCITA P BUNGAY CARMENCITA P. BUNGAY

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 E FOOTHILL BLVD
PASADENA CA
91107-3439
US

IV. Provider business mailing address

2650 E FOOTHILL BLVD
PASADENA CA
91107-3439
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2261
  • Fax:
Mailing address:
  • Phone: 626-577-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN177332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: