Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | A122210 | CA |
NPI | 1033386537 |
---|---|
Provider Name | Manuel M Buitrago Blanco |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 15/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033386537 | MEDI CAL (01) | CA |