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General NPI Number Information
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NPI Number | 1528195625
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Entity Type | Organization
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Legal Business Name | ROMAN P. BUKACHEVSKY, MD, INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 295 POSADA LN SUITE B
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City | TEMPLETON
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State | CA
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Zip | 93465-4055
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Country | US
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Telephone | 805-434-5960
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Fax | 805-434-5963
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Provider Business Mailing Address
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Address Line | 295 POSADA LN SUITE B
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City | TEMPLETON
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State | CA
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Zip | 93465-4055
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Country | US
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Telephone | 805-434-5960
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Fax | 805-434-5963
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Authorized Official
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Title or Position | INCORPORATOR
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Name | DR. ROMAN P BUKACHEVSKY
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Credential | M.D.
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Telephone | 805-434-5960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G71259
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License Number State | CA
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