Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC16488 | CA |
NPI | 1003987322 |
---|---|
Provider Name | Dr. Paul Federick Pugsley |
First Address | Spring Valley, CA 91977-1609 |
Second Address | Spring Valley, CA 91977-1609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T18347 | (02) | CA |