Provider Demographics
NPI:1487031241
Name:BUNGCAYAO, DANAELIZABETH (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:DANAELIZABETH
Middle Name:
Last Name:BUNGCAYAO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:BUNGCAYAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1267 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5210
Mailing Address - Country:US
Mailing Address - Phone:408-265-4211
Mailing Address - Fax:
Practice Address - Street 1:1267 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5210
Practice Address - Country:US
Practice Address - Phone:408-265-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist