Healthcare Provider Details

I. General information

NPI: 1982919890
Provider Name (Legal Business Name): JUANITA BUITRAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PAGE ST
SAN FRANCISCO CA
94102-5811
US

IV. Provider business mailing address

775 SWEENY ST
SAN FRANCISCO CA
94134-1015
US

V. Phone/Fax

Practice location:
  • Phone: 415-553-3252
  • Fax: 415-553-8311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number147359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: