=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316025539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUGMAN, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9515 CANTURA CRST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78250-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-289-1582
-----------------------------------------------------
Fax | 210-680-1180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9515 CANTURA CRST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78250-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-289-1582
-----------------------------------------------------
Fax | 210-680-1180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN-ADM
-----------------------------------------------------
Name | MS. UGO CHINYERE UWAKA
-----------------------------------------------------
Credential | BSN-RN
-----------------------------------------------------
Telephone | 210-289-1582
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 009747
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------