=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720883796
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA D BUCIO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2025
-----------------------------------------------------
Last Update Date | 02/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 347 VILLAGE AVE
-----------------------------------------------------
City | SHAFTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93263-2562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-240-0841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4605 TRIPLE CROWN DR
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93312-5126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-858-6989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------