Individual
MAN Y PUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8860 CENTER DR STE 460, LA MESA, CA 91942-7001
(619) 463-3773
Mailing address
8860 CENTER DR STE 460, LA MESA, CA 91942-7001
(619) 463-3773
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
59205
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144711979
CORP NPI #
CA
01
—
823905981
CORP TAX ID
CA
Enumeration date
04/11/2007
Last updated
08/23/2022
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