Provider Demographics
NPI:1245659655
Name:PUNO, MARIA REGINA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:REGINA
Last Name:PUNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:M REGINA
Other - Middle Name:B
Other - Last Name:PUNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5956 TIMBER RIDGE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8147
Mailing Address - Country:US
Mailing Address - Phone:502-821-5269
Mailing Address - Fax:502-214-5919
Practice Address - Street 1:5956 TIMBER RIDGE DR STE 101
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8147
Practice Address - Country:US
Practice Address - Phone:502-821-5269
Practice Address - Fax:502-214-5919
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26052207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64260524Medicaid
KY64260524Medicaid