Provider Demographics
NPI:1104243716
Name:PUIG, NICOLAS
Entity type:Individual
Prefix:MR
First Name:NICOLAS
Middle Name:
Last Name:PUIG
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 1:1511 GLASHOLM DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-6185
Mailing Address - Country:US
Mailing Address - Phone:917-378-5003
Mailing Address - Fax:
Practice Address - Street 1:1511 GLASHOLM DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-6185
Practice Address - Country:US
Practice Address - Phone:917-378-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health