Provider Demographics
NPI:1700774734
Name:PUNZALAN, BERMON WREN REYES (CRNA)
Entity type:Individual
Prefix:
First Name:BERMON WREN
Middle Name:REYES
Last Name:PUNZALAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N STATE COLLEGE BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1625
Mailing Address - Country:US
Mailing Address - Phone:224-600-2784
Mailing Address - Fax:
Practice Address - Street 1:500 N STATE COLLEGE BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1625
Practice Address - Country:US
Practice Address - Phone:224-600-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002704367500000X
IL209033305367500000X
CA95196322163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse