Healthcare Provider Details

I. General information

NPI: 1811146202
Provider Name (Legal Business Name): MRS. MICHELLE MADRIGAL BUGARIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E WALNUT ST ROOM 200
PASADENA CA
91101-1580
US

IV. Provider business mailing address

300 E WALNUT ST ROOM 200
PASADENA CA
91101-1580
US

V. Phone/Fax

Practice location:
  • Phone: 626-356-5311
  • Fax: 626-568-9461
Mailing address:
  • Phone: 626-356-5311
  • Fax: 626-568-9461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberA9284191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: