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General NPI Number Information
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NPI Number | 1902799760
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Entity Type | Individual
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Provider Name | MARGARITA DIAZ BUAN PTA
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Gender | Female
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 4867 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-5969
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Country | US
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Telephone | 253-228-2578
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Fax |
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Provider Business Mailing Address
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Address Line | 1136 N COLUMBUS AVE APT 107
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City | GLENDALE
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State | CA
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Zip | 91202-2373
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Country | US
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Telephone | 253-228-2578
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 51969
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License Number State | CA
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