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General NPI Number Information
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NPI Number | 1063677730
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Entity Type | Individual
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Provider Name | HOMA A PUGA B.B.A
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Gender | Female
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 9306 OLD KEENE MILL RD STE A
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City | BURKE
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State | VA
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Zip | 22015-4280
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Country | US
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Telephone | 703-440-1131
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Fax | 703-440-1132
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Provider Business Mailing Address
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Address Line | 9306 OLD KEENE MILL RD STE A
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City | BURKE
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State | VA
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Zip | 22015-4280
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Country | US
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Telephone | 703-440-1131
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Fax | 703-440-1402
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 80167276
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License Number State | VA
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