Healthcare Provider Details

I. General information

NPI: 1386710531
Provider Name (Legal Business Name): MARIA BUGARIN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W FIR AVE SUITE 101
CLOVIS CA
93611-0223
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-7294
  • Fax: 559-299-0641
Mailing address:
  • Phone: 805-361-8028
  • Fax: 805-361-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC 14796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: