Healthcare Provider Details

I. General information

NPI: 1174880793
Provider Name (Legal Business Name): MARSHA N BUDHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15342 HAWTHORNE BLVD SUITE 102
LAWNDALE CA
90260-2152
US

IV. Provider business mailing address

5770 W CENTINELA AVE 407
LOS ANGELES CA
90045-8828
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-8400
  • Fax:
Mailing address:
  • Phone: 323-872-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: