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General NPI Number Information
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NPI Number | 1568175131
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Entity Type | Individual
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Provider Name | EMMANUEL BUAKO
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Gender | Male
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 1701 ZONAL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90033-1065
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Country | US
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Telephone | 323-223-6298
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Fax |
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Provider Business Mailing Address
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Address Line | 4510 PINAFORE ST APT 10
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City | LOS ANGELES
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State | CA
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Zip | 90008-2210
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Country | US
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Telephone | 323-395-6483
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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 | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | PT36991
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License Number State | CA
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