Provider Demographics
NPI:1659751782
Name:DUNGCA, REYNALDO JAMES III (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:JAMES
Last Name:DUNGCA
Suffix:III
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:DUNGCA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5720 RALSTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7844
Mailing Address - Country:US
Mailing Address - Phone:805-804-4168
Mailing Address - Fax:805-830-1177
Practice Address - Street 1:3901 LAS POSAS RD STE 8
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1502
Practice Address - Country:US
Practice Address - Phone:805-585-3607
Practice Address - Fax:805-348-1786
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11678225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11678OtherSTATE LICENSE