MEDICARE: ELIZABETH LOAN BUIBICH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A52634	CA

General Provider Information

NPI Number	:	1588876437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LOAN BUIBICH MD

Provider Business Mailing Address
First Line	:	174 AMBLING DRIVE
Second Line	:
City	:	BREA
State	:	CA
Zip	:	92821
Country	:	US
Telephone Number	:	714-539-8937
Fax Number	:

Provider Business Practice Location Address
First Line	:	5015 WEST EDINGER AVE., STES K-L
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704
Country	:	US
Telephone Number	:	714-418-2040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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