Healthcare Provider Details

I. General information

NPI: 1437639796
Provider Name (Legal Business Name): DAIANA BUCIO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 S BUENA VISTA ST
BURBANK CA
91505-4504
US

IV. Provider business mailing address

1394 MIDVALE AVE APT 209
LOS ANGELES CA
90024-6202
US

V. Phone/Fax

Practice location:
  • Phone: 818-748-4748
  • Fax:
Mailing address:
  • Phone: 707-494-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC001011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: