Healthcare Provider Details

I. General information

NPI: 1295086163
Provider Name (Legal Business Name): ELENA JAKLIN BUDAGYAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 GARVEY AVE #111
EL MONTE CA
91733-2088
US

IV. Provider business mailing address

10050 GARVEY AVE #111
EL MONTE CA
91733-2088
US

V. Phone/Fax

Practice location:
  • Phone: 626-652-0790
  • Fax: 626-652-0799
Mailing address:
  • Phone: 626-652-0790
  • Fax: 626-652-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA22502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: