Healthcare Provider Details

I. General information

NPI: 1912911264
Provider Name (Legal Business Name): MAGDALENA G. BUSLON R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 NORDHOFF ST
NORTHRIDGE CA
91330-8270
US

IV. Provider business mailing address

8801 INDEPENDENCE AVE APT 22
CANOGA PARK CA
91304-1719
US

V. Phone/Fax

Practice location:
  • Phone: 818-677-3666
  • Fax: 818-677-2304
Mailing address:
  • Phone: 818-700-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN214913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: