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General NPI Number Information
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NPI Number | 1790105419
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Entity Type | Individual
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Provider Name | TARA BUI MA
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Gender | Female
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 4325 W SUNSET BLVD STE 206
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City | LOS ANGELES
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State | CA
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Zip | 90029-2180
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Country | US
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Telephone | 626-484-5531
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Fax |
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Provider Business Mailing Address
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Address Line | 130 VALLEY ST UNIT 4021
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City | PASADENA
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State | CA
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Zip | 91105-4164
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Country | US
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Telephone | 626-484-5531
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 114563
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT114563
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License Number State | CA
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