Basic Information
| Provider Information | |||||||||
| NPI: | 1952427940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUGH | ||||||||
| FirstName: | BILLY | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2640 INDUSTRY WAY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902624000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106274525 | ||||||||
| FaxNumber: | 3106274531 | ||||||||
| Practice Location | |||||||||
| Address1: | 2640 INDUSTRY WAY | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902624000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106395983 | ||||||||
| FaxNumber: | 3106315875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 03/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.