Provider Demographics
NPI:1104414101
Name:BUNAG, MICHAEL JOHN PANCHO (NP)
Entity type:Individual
Prefix:
First Name:MICHAEL JOHN
Middle Name:PANCHO
Last Name:BUNAG
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:17101 SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6240
Mailing Address - Country:US
Mailing Address - Phone:818-333-6378
Mailing Address - Fax:813-333-6378
Practice Address - Street 1:100 N BARRANCA ST STE 900
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1637
Practice Address - Country:US
Practice Address - Phone:626-206-0523
Practice Address - Fax:626-206-0553
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2023-09-27
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Provider Licenses
StateLicense IDTaxonomies
CA95016175363L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine