Provider Demographics
NPI:1548355548
Name:PUGAO, IRISH FAYE RIVERA (PA)
Entity type:Individual
Prefix:MRS
First Name:IRISH FAYE
Middle Name:RIVERA
Last Name:PUGAO
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1485 GEORGE DIETER DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7650
Mailing Address - Country:US
Mailing Address - Phone:915-790-5700
Mailing Address - Fax:915-521-7082
Practice Address - Street 1:1485 GEORGE DIETER DR
Practice Address - Street 2:SUITE 107
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7650
Practice Address - Country:US
Practice Address - Phone:915-790-5700
Practice Address - Fax:915-521-7082
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-02-06
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Provider Licenses
StateLicense IDTaxonomies
LAPA.200174.RX363A00000X
TXPA07983363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant