MEDICARE: MR. REYNALDO JAMES DUNGCA III OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	11678	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11678	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1659751782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REYNALDO JAMES DUNGCA III OTR/L

Provider Business Mailing Address
First Line	:	5720 RALSTON ST STE 200
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-7844
Country	:	US
Telephone Number	:	805-804-4168
Fax Number	:	805-830-1177

Provider Business Practice Location Address
First Line	:	3901 LAS POSAS RD STE 8
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1502
Country	:	US
Telephone Number	:	805-585-3607
Fax Number	:	805-348-1786

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	10/01/2022

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