Provider Demographics
NPI:1356090138
Name:FUGABAN, ANGEL CHERLYN
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:CHERLYN
Last Name:FUGABAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30502 BRETTON ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1703
Mailing Address - Country:US
Mailing Address - Phone:734-673-4720
Mailing Address - Fax:
Practice Address - Street 1:30502 BRETTON ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1703
Practice Address - Country:US
Practice Address - Phone:734-673-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator