Healthcare Provider Details

I. General information

NPI: 1750762423
Provider Name (Legal Business Name): CAROLINA BUGARIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 07/21/2022
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HURLBUT ST
PASADENA CA
91105-4025
US

IV. Provider business mailing address

66 HURLBUT ST
PASADENA CA
91105-4025
US

V. Phone/Fax

Practice location:
  • Phone: 626-422-4221
  • Fax:
Mailing address:
  • Phone: 626-422-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number72411
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: