Provider Demographics
NPI:1316640659
Name:LABISTRE, CARMENCITA BUNGAY
Entity type:Individual
Prefix:
First Name:CARMENCITA
Middle Name:BUNGAY
Last Name:LABISTRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARMENCITA
Other - Middle Name:P
Other - Last Name:BUNGAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CARMENCITA P BUNGAY
Mailing Address - Street 1:2650 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3439
Mailing Address - Country:US
Mailing Address - Phone:626-577-2261
Mailing Address - Fax:
Practice Address - Street 1:2650 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3439
Practice Address - Country:US
Practice Address - Phone:626-577-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN177332164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse