Healthcare Provider Details
I. General information
NPI: 1629022314
Provider Name (Legal Business Name): ASHLEY BUSUTTIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/19/2006
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
757 WESTWOOD PLZ SUITE 7501
LOS ANGELES CA
90095-3075
US
IV. Provider business mailing address
5767 W. CENTURY BLVD #400
LOS ANGELES CA
90045-5655
US
V. Phone/Fax
- Phone: 310-267-9643
- Fax: 310-267-3840
- Phone: 310-267-9643
- Fax: 310-206-3551
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208M00000X |
| Taxonomy | Hospitalist Physician |
| License Number | A90390 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: