Healthcare Provider Details

I. General information

NPI: 1386897130
Provider Name (Legal Business Name): JOANNE PAMELA PARUNGAO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 COCHRAN ST SUITE D
SIMI VALLEY CA
93065-2796
US

IV. Provider business mailing address

2845 COCHRAN ST SUITE D
SIMI VALLEY CA
93065-2796
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-6824
  • Fax: 805-527-9247
Mailing address:
  • Phone: 805-527-6824
  • Fax: 805-527-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13890TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: