Provider Demographics
NPI:1225715311
Name:PUNNEN, TRUC
Entity Type:Individual
Prefix:
First Name:TRUC
Middle Name:
Last Name:PUNNEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 WILD SKIES DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-4689
Mailing Address - Country:US
Mailing Address - Phone:702-496-4405
Mailing Address - Fax:
Practice Address - Street 1:964 WILD SKIES DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-4689
Practice Address - Country:US
Practice Address - Phone:702-496-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39219-DI-3133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered