Provider Demographics
NPI:1326178534
Name:PUGA, ANNETTE MARIE
Entity type:Individual
Prefix:MISS
First Name:ANNETTE
Middle Name:MARIE
Last Name:PUGA
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:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90637-0344
Mailing Address - Country:US
Mailing Address - Phone:909-422-6550
Mailing Address - Fax:
Practice Address - Street 1:554 E FOOTHILL BLVD STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1222
Practice Address - Country:US
Practice Address - Phone:909-422-6550
Practice Address - Fax:909-703-2850
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical