Healthcare Provider Details

I. General information

NPI: 1790307973
Provider Name (Legal Business Name): RITA JOANNA PUGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E HACKETT RD
MODESTO CA
95358-9001
US

IV. Provider business mailing address

800 SCENIC DR BLDG G
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-2085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: