1487881447 NPI number — PUREZA PUGA R.D.H.

Table of content: PUREZA PUGA R.D.H. (NPI 1487881447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487881447 NPI number — PUREZA PUGA R.D.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUGA
Provider First Name:
PUREZA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.D.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487881447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4801 WILSON RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77396-1975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-441-1065
Provider Business Mailing Address Fax Number:
281-441-1505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4801 WILSON RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77396-1975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-441-1065
Provider Business Practice Location Address Fax Number:
281-441-1505
Provider Enumeration Date:
06/17/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  7920 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)