Provider Demographics
NPI:1942263629
Name:PUA, ZENAIDA V (MD)
Entity Type:Individual
Prefix:
First Name:ZENAIDA
Middle Name:V
Last Name:PUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N EMMETT ST
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-1615
Mailing Address - Country:US
Mailing Address - Phone:256-891-0300
Mailing Address - Fax:256-891-7461
Practice Address - Street 1:203 N EMMETT ST
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1615
Practice Address - Country:US
Practice Address - Phone:256-891-0300
Practice Address - Fax:256-891-7461
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4515208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000024285Medicaid
ALD08215Medicare UPIN