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General NPI Number Information
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NPI Number | 1972196632
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Entity Type | Individual
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Provider Name | MRS. LUISA MARIA BUITRAGO
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Gender | Female
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Dates
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Enumeration Date | 02/13/2021
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 95 PLEASANT ST
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City | LYNN
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State | MA
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Zip | 01901-1524
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Country | US
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Telephone | 954-629-6508
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Fax |
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Provider Business Mailing Address
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Address Line | 422 WASHINGTON AVE UNIT A
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City | CHELSEA
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State | MA
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Zip | 02150-3640
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Country | US
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Telephone | 617-504-4276
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2359183
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License Number State | MA
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