Healthcare Provider Details

I. General information

NPI: 1629648746
Provider Name (Legal Business Name): MARIA PERLA LEGASPI BUENAFLOR-SALES AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SAND CREEK RD STE 236
BRENTWOOD CA
94513-7302
US

IV. Provider business mailing address

50 SAND CREEK RD STE 236
BRENTWOOD CA
94513-7302
US

V. Phone/Fax

Practice location:
  • Phone: 925-550-1494
  • Fax:
Mailing address:
  • Phone: 925-550-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95017186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: