Healthcare Provider Details

I. General information

NPI: 1255506960
Provider Name (Legal Business Name): JOANNE PUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 RODRIGUEZ ST
WATSONVILLE CA
95076-4212
US

IV. Provider business mailing address

640 RODRIGUEZ ST
WATSONVILLE CA
95076-4212
US

V. Phone/Fax

Practice location:
  • Phone: 831-722-2471
  • Fax: 831-768-9253
Mailing address:
  • Phone: 831-722-2471
  • Fax: 831-768-9253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: