Healthcare Provider Details

I. General information

NPI: 1467842849
Provider Name (Legal Business Name): MISS MARIE BUETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 PAINTER AVE
WHITTIER CA
90602-3158
US

IV. Provider business mailing address

8135 PAINTER AVE
WHITTIER CA
90602-3158
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • Fax: 562-698-6613
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberD6975293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: