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General NPI Number Information
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NPI Number | 1396183703
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Entity Type | Individual
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Provider Name | BRIAN BUCKLEY MD MPH
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Gender | Male
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 12291 WASHINGTON BLVD SUITE 500
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City | WHITTIER
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State | CA
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Zip | 90606-2500
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Country | US
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Telephone | 562-698-0811
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Fax | 562-789-4339
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Provider Business Mailing Address
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Address Line | 718 N MONTEREY ST APT. 106
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City | ALHAMBRA
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State | CA
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Zip | 91801-1586
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Country | US
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Telephone | 516-661-7575
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A134294
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License Number State | CA
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