Provider Demographics
NPI:1538496393
Name:PUGACH, LYUDMILA (RN)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:PUGACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 DELLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1841
Mailing Address - Country:US
Mailing Address - Phone:925-240-7781
Mailing Address - Fax:
Practice Address - Street 1:1055 DELLWOOD CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1841
Practice Address - Country:US
Practice Address - Phone:925-240-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-14
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN731675163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health