Provider Demographics
NPI:1992475925
Name:PUGAY, RODORA
Entity type:Individual
Prefix:
First Name:RODORA
Middle Name:
Last Name:PUGAY
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 1:3614 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3041
Mailing Address - Country:US
Mailing Address - Phone:907-317-5627
Mailing Address - Fax:
Practice Address - Street 1:3614 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3041
Practice Address - Country:US
Practice Address - Phone:907-317-5627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility