Provider Demographics
NPI:1326214818
Name:ALICIA G NUGAS MD INC
Entity Type:Organization
Organization Name:ALICIA G NUGAS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHERRYL
Authorized Official - Middle Name:NUGAS
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-421-2199
Mailing Address - Street 1:PO BOX 4838
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-4838
Mailing Address - Country:US
Mailing Address - Phone:562-421-2188
Mailing Address - Fax:562-421-3934
Practice Address - Street 1:22408 NORWALK BLVD
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-1546
Practice Address - Country:US
Practice Address - Phone:562-421-2188
Practice Address - Fax:562-421-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34342261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34342Medicare PIN