Provider Demographics
NPI:1982982997
Name:PUGAO, RHODORA
Entity Type:Individual
Prefix:MS
First Name:RHODORA
Middle Name:
Last Name:PUGAO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:YEYE
Other - Middle Name:
Other - Last Name:PUGAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD
Mailing Address - Street 1:8050 E HWY 191
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8613
Mailing Address - Country:US
Mailing Address - Phone:432-640-2128
Mailing Address - Fax:432-640-2428
Practice Address - Street 1:8050 E HWY 191
Practice Address - Street 2:SUITE 103
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8613
Practice Address - Country:US
Practice Address - Phone:432-640-2128
Practice Address - Fax:432-640-2428
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81951133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered