Healthcare Provider Details

I. General information

NPI: 1780087601
Provider Name (Legal Business Name): CATHERINE B PUANGCO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N 7TH AVE
MOUNT VERNON NY
10550-2026
US

IV. Provider business mailing address

PO BOX 750764
FOREST HILLS NY
11375-0764
US

V. Phone/Fax

Practice location:
  • Phone: 914-361-6277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338672
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95001361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: