Provider Demographics
NPI:1780490482
Name:PUHA, RUBEN D
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:D
Last Name:PUHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 W WEST WIND DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2934
Mailing Address - Country:US
Mailing Address - Phone:708-717-4681
Mailing Address - Fax:
Practice Address - Street 1:5332 W WEST WIND DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-2934
Practice Address - Country:US
Practice Address - Phone:708-717-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program