Healthcare Provider Details

I. General information

NPI: 1639960131
Provider Name (Legal Business Name): ERNESTO PUZON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 S RIVER ROCK DR
PAPILLION NE
68046-2774
US

IV. Provider business mailing address

11110 FORT ST STE 103
OMAHA NE
68164-2183
US

V. Phone/Fax

Practice location:
  • Phone: 515-306-4617
  • Fax:
Mailing address:
  • Phone: 402-730-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: