Provider Demographics
NPI:1427598705
Name:PURUGGANAN, MA TERESITA CRUZ
Entity Type:Individual
Prefix:
First Name:MA TERESITA
Middle Name:CRUZ
Last Name:PURUGGANAN
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 1:111 COLLEGE RD
Mailing Address - Street 2:APT 5 O
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2800
Mailing Address - Country:US
Mailing Address - Phone:631-880-2337
Mailing Address - Fax:
Practice Address - Street 1:111 COLLEGE RD
Practice Address - Street 2:APT 5 O
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2800
Practice Address - Country:US
Practice Address - Phone:631-880-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY590793163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse