Provider Demographics
NPI:1881209443
Name:BUGALA, REBECCA J
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:BUGALA
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 1:40096 POLAND RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:OH
Mailing Address - Zip Code:43977-9767
Mailing Address - Country:US
Mailing Address - Phone:740-968-4904
Mailing Address - Fax:
Practice Address - Street 1:40096 POLAND RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:OH
Practice Address - Zip Code:43977-9767
Practice Address - Country:US
Practice Address - Phone:740-968-4904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0303647Medicaid