Healthcare Provider Details

I. General information

NPI: 1457382533
Provider Name (Legal Business Name): ALFRED BUDRIS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LINDEN AVE
LONG BEACH CA
90813-3321
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-9000
  • Fax:
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG10876
License Number StateCA

VIII. Authorized Official

Name: DR. ALFRED V BUDRIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243