Healthcare Provider Details

I. General information

NPI: 1992836985
Provider Name (Legal Business Name): BRENDA JOYCE BUCHANAN-VEGA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 S OLIVE ST
LOS ANGELES CA
90015-3023
US

IV. Provider business mailing address

323 N WALNUTHAVEN DR
WEST COVINA CA
91790-1657
US

V. Phone/Fax

Practice location:
  • Phone: 213-747-5542
  • Fax:
Mailing address:
  • Phone: 626-337-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMF1432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: