Provider Demographics
NPI:1558843193
Name:BUGHO, ANDRE AGUSTIN
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:AGUSTIN
Last Name:BUGHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5378 W MILLBRAE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3666
Mailing Address - Country:US
Mailing Address - Phone:559-548-0325
Mailing Address - Fax:
Practice Address - Street 1:5378 W MILLBRAE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3666
Practice Address - Country:US
Practice Address - Phone:559-548-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582520163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse