Provider Demographics
NPI:1811329048
Name:PUBUZHUOGA, NONAME
Entity type:Individual
Prefix:
First Name:NONAME
Middle Name:
Last Name:PUBUZHUOGA
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 1:2460 22ND ST,BLDG 90, 4TH FLOOR
Mailing Address - Street 2:TB CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-206-3288
Mailing Address - Fax:415-206-4565
Practice Address - Street 1:2460 22ND ST,BLDG 90, 4TH FLOOR
Practice Address - Street 2:TB CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-206-3288
Practice Address - Fax:415-206-4565
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACPT30943246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy