Provider Demographics
NPI:1629567276
Name:PUGA, ARSELIA
Entity Type:Individual
Prefix:
First Name:ARSELIA
Middle Name:
Last Name:PUGA
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 1:1234 ELM CT
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4249
Mailing Address - Country:US
Mailing Address - Phone:559-362-6326
Mailing Address - Fax:
Practice Address - Street 1:2934 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1123
Practice Address - Country:US
Practice Address - Phone:559-549-6697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
167G00000X
CA35128167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician