=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467267740
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANHTHU NGOC BUI RRA/RPA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2025
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23961 CALLE DE LA MAGDALENA STE 130
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-855-4301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13066 E 106TH AVE
-----------------------------------------------------
City | COMMERCE CITY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80022-8889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 243U00000X
-----------------------------------------------------
Taxonomy Name | Radiology Practitioner Assistant
-----------------------------------------------------
License Number | 22O2045
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------