Healthcare Provider Details

I. General information

NPI: 1811597974
Provider Name (Legal Business Name): EMILY JESSICA BUJAN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E FRUIT ST
SANTA ANA CA
92701-4296
US

IV. Provider business mailing address

1207 E FRUIT ST
SANTA ANA CA
92701-4296
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-9373
  • Fax: 714-418-4634
Mailing address:
  • Phone: 714-953-9373
  • Fax: 714-418-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number274424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: