Provider Demographics
NPI:1699163493
Name:PUGH, LOUISE M
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:M
Last Name:PUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:M
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9640 BRADHUGH CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3209
Mailing Address - Country:US
Mailing Address - Phone:916-308-3407
Mailing Address - Fax:
Practice Address - Street 1:9640 BRADHUGH CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3209
Practice Address - Country:US
Practice Address - Phone:916-308-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit