Provider Demographics
NPI:1770205106
Name:PARUNGAO, DARYL PONCE
Entity type:Individual
Prefix:PROF
First Name:DARYL
Middle Name:PONCE
Last Name:PARUNGAO
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 1:818 LAMONT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5466
Mailing Address - Country:US
Mailing Address - Phone:573-544-6680
Mailing Address - Fax:
Practice Address - Street 1:325 N STATE OF FRANKLIN RD FL 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6092
Practice Address - Country:US
Practice Address - Phone:423-439-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program