Provider Demographics
NPI:1417069501
Name:BUGARIN, FELICITAS CRUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICITAS
Middle Name:CRUZ
Last Name:BUGARIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FELICITAS
Other - Middle Name:C
Other - Last Name:BUGARIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512
Mailing Address - Country:US
Mailing Address - Phone:843-454-0442
Mailing Address - Fax:843-454-0212
Practice Address - Street 1:1035 CHERAW ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-454-0442
Practice Address - Fax:843-454-0212
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid
SC3343Medicare ID - Type Unspecified