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General NPI Number Information
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NPI Number | 1023850435
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Entity Type | Organization
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Legal Business Name | MY PERSONAL CARE
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 930 COACH ST
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City | STOCKTON
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State | CA
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Zip | 95209-1438
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Country | US
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Telephone | 209-477-4048
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Fax |
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Provider Business Mailing Address
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Address Line | 6333 PACIFIC AVE UNIT 555
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City | STOCKTON
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State | CA
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Zip | 95207-3713
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Country | US
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Telephone | 916-203-9845
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NORENCIO S BUNGALON
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Credential |
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Telephone | 916-203-9845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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