Provider Demographics
NPI:1255467791
Name:DUNNE, MYLA JUNE (OTC)
Entity Type:Individual
Prefix:
First Name:MYLA
Middle Name:JUNE
Last Name:DUNNE
Suffix:
Gender:F
Credentials:OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 OAKDALE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3381
Mailing Address - Country:US
Mailing Address - Phone:209-571-5071
Mailing Address - Fax:209-577-1157
Practice Address - Street 1:1501 OAKDALE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3381
Practice Address - Country:US
Practice Address - Phone:209-571-5071
Practice Address - Fax:209-577-1157
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87-0536247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other