Healthcare Provider Details

I. General information

NPI: 1669578241
Provider Name (Legal Business Name): GILBERT ALFORT BUSH MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 N MOUNTAIN AVE
ONTARIO CA
91762-2544
US

IV. Provider business mailing address

16702 VALLEY VIEW AVE
LA MIRADA CA
90638-5824
US

V. Phone/Fax

Practice location:
  • Phone: 909-460-4155
  • Fax: 909-988-4414
Mailing address:
  • Phone: 714-367-5360
  • Fax: 714-635-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA32872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: