Healthcare Provider Details

I. General information

NPI: 1245606672
Provider Name (Legal Business Name): JAMILIE BUMATAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 LINCOLN GLEN DR
BUENA PARK CA
90620-4232
US

IV. Provider business mailing address

813 LINCOLN GLEN DR
BUENA PARK CA
90620-4232
US

V. Phone/Fax

Practice location:
  • Phone: 714-222-3321
  • Fax:
Mailing address:
  • Phone: 714-222-3321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: