Healthcare Provider Details

I. General information

NPI: 1508814294
Provider Name (Legal Business Name): VALA VL BUJAK MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N MAIN ST
MONTICELLO IN
47960-1757
US

IV. Provider business mailing address

801 N MAIN ST
MONTICELLO IN
47960-1757
US

V. Phone/Fax

Practice location:
  • Phone: 574-583-6601
  • Fax: 574-583-6601
Mailing address:
  • Phone: 574-583-6601
  • Fax: 574-583-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number23002220A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17000695A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: