Provider Demographics
NPI:1083506232
Name:PUNLA, MYRA E (PROSTHETIST)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:E
Last Name:PUNLA
Suffix:
Gender:F
Credentials:PROSTHETIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2235
Mailing Address - Country:US
Mailing Address - Phone:707-679-0337
Mailing Address - Fax:
Practice Address - Street 1:110 41ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5250
Practice Address - Country:US
Practice Address - Phone:707-679-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZR06096F224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist