Provider Demographics
NPI:1306161674
Name:POGUE, MG (ATC, NREMT-B, CES)
Entity type:Individual
Prefix:
First Name:MG
Middle Name:
Last Name:POGUE
Suffix:
Gender:F
Credentials:ATC, NREMT-B, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 ALLISON WAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3114
Mailing Address - Country:US
Mailing Address - Phone:408-838-3832
Mailing Address - Fax:
Practice Address - Street 1:808 ALLISON WAY
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3114
Practice Address - Country:US
Practice Address - Phone:408-838-3832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer