Provider Demographics
NPI:1467992917
Name:PUNGUS, JANI
Entity Type:Individual
Prefix:
First Name:JANI
Middle Name:
Last Name:PUNGUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7319 S CODY ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4210
Mailing Address - Country:US
Mailing Address - Phone:269-262-2528
Mailing Address - Fax:
Practice Address - Street 1:7319 S CODY ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4210
Practice Address - Country:US
Practice Address - Phone:269-262-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities