Provider Demographics
NPI:1063185270
Name:BUNUAN, DOUGLAS ALEJO
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALEJO
Last Name:BUNUAN
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 1:209 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2559
Mailing Address - Country:US
Mailing Address - Phone:707-328-2259
Mailing Address - Fax:
Practice Address - Street 1:209 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2559
Practice Address - Country:US
Practice Address - Phone:707-328-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15108225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist