Healthcare Provider Details

I. General information

NPI: 1710721071
Provider Name (Legal Business Name): JOAN PERIDO DUNGO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

2483 MIDDLEFIELD RD APT 1
REDWOOD CITY CA
94063-2840
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-1890
  • Fax: 650-369-6465
Mailing address:
  • Phone: 662-715-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95338811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: