Provider Demographics
NPI:1689639163
Name:PUGA, ANA M (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:PUGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:4101 NW 3RD CT STE 9
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2830
Mailing Address - Country:US
Mailing Address - Phone:754-701-6911
Mailing Address - Fax:954-595-2103
Practice Address - Street 1:4101 NW 3RD CT STE 9
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2830
Practice Address - Country:US
Practice Address - Phone:754-701-6911
Practice Address - Fax:954-595-2103
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME641182080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377748100Medicaid
G65715Medicare UPIN
E0364Medicare ID - Type Unspecified