Healthcare Provider Details

I. General information

NPI: 1376043133
Provider Name (Legal Business Name): ALLESA RACHELLE BUMGARDNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLESA RACHELLE BUMGARDNER MCCAUL

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 WASHINGTON BLVD STE 400
WHITTIER CA
90602-1006
US

IV. Provider business mailing address

IEMG 12401 WASHINGTON BLVD
WHITTIER CA
90602-1006
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0811
  • Fax:
Mailing address:
  • Phone: 562-698-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: