Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | NP12567 | CA |
NPI | 1023077492 |
---|---|
Provider Name | Angelita Domingo Bueno |
First Address | Carson, CA 90745-3100 |
Second Address | Harbor City, CA 90710-2076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 07/12/2011 |