Provider Demographics
NPI:1710444088
Name:PUGA, SYDNEY
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:PUGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13701 PISTACHIO ST
Mailing Address - Street 2:
Mailing Address - City:ARMONA
Mailing Address - State:CA
Mailing Address - Zip Code:93202-9758
Mailing Address - Country:US
Mailing Address - Phone:559-309-0635
Mailing Address - Fax:
Practice Address - Street 1:2025 E NOBLE AVE STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-1520
Practice Address - Country:US
Practice Address - Phone:559-372-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician