Healthcare Provider Details

I. General information

NPI: 1609203900
Provider Name (Legal Business Name): FRAGRANCE BUMATAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 07/16/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 E ATHERTON ST
LONG BEACH CA
90815-3700
US

IV. Provider business mailing address

7601 EAST IMPERIAL HWY
DOWNEY CA
90242-3456
US

V. Phone/Fax

Practice location:
  • Phone: 562-961-0155
  • Fax: 562-961-0161
Mailing address:
  • Phone: 562-401-6535
  • Fax: 562-401-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCA
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number23118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: