Provider Demographics
NPI:1659470789
Name:PUNO, MARIA ADELMA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA ADELMA
Middle Name:
Last Name:PUNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MA ADELMA
Other - Middle Name:S
Other - Last Name:PUNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1550 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6901
Mailing Address - Country:US
Mailing Address - Phone:707-427-4025
Mailing Address - Fax:707-427-4335
Practice Address - Street 1:1550 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6901
Practice Address - Country:US
Practice Address - Phone:707-427-4025
Practice Address - Fax:707-427-4335
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMP079587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI207Q00000XMedicaid
MI4301079587OtherSTATE LICENSE NUMBER