Provider Demographics
NPI:1376932483
Name:PUSAG, ANNABELLE
Entity Type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:
Last Name:PUSAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNABELLE
Other - Middle Name:ALAMEDA
Other - Last Name:ALONZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2705 MELVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2903
Mailing Address - Country:US
Mailing Address - Phone:626-524-8193
Mailing Address - Fax:
Practice Address - Street 1:2705 MELVILLE DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2903
Practice Address - Country:US
Practice Address - Phone:626-524-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist