Provider Demographics
NPI:1508528415
Name:BUGHO, NERISSE
Entity Type:Individual
Prefix:
First Name:NERISSE
Middle Name:
Last Name:BUGHO
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 1:3636 N 1ST ST STE 162
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6869
Mailing Address - Country:US
Mailing Address - Phone:559-476-2166
Mailing Address - Fax:
Practice Address - Street 1:3636 N 1ST ST STE 162
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6869
Practice Address - Country:US
Practice Address - Phone:559-476-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker