Provider Demographics
NPI:1750016374
Name:PUGLIESE, MADONNA N
Entity type:Individual
Prefix:
First Name:MADONNA
Middle Name:N
Last Name:PUGLIESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DONNIE
Other - Middle Name:N
Other - Last Name:PUGLIESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1275
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-1275
Mailing Address - Country:US
Mailing Address - Phone:714-362-7740
Mailing Address - Fax:
Practice Address - Street 1:23461 S POINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1523
Practice Address - Country:US
Practice Address - Phone:949-452-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist