Provider Demographics
NPI:1841214707
Name:PENDLEBERRY, BRUCE (OMD, LAC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:PENDLEBERRY
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 E THOUSAND OAKS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6258
Mailing Address - Country:US
Mailing Address - Phone:805-380-5742
Mailing Address - Fax:805-495-1390
Practice Address - Street 1:1325 E THOUSAND OAKS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-6258
Practice Address - Country:US
Practice Address - Phone:805-380-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3122171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist