Healthcare Provider Details

I. General information

NPI: 1295980308
Provider Name (Legal Business Name): DARLENE M BUGOCI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 W SUNSET BLVD 2ND FLOOR RADIATION ONCOLOGY
LOS ANGELES CA
90027-5822
US

IV. Provider business mailing address

4950 W SUNSET BLVD 2ND FLOOR RADIATION ONCOLOGY
LOS ANGELES CA
90027-5822
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-3719
  • Fax: 323-783-5927
Mailing address:
  • Phone: 323-783-3719
  • Fax: 323-783-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA104165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: