MEDICARE: HAILEY BUITRAGO

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	106H00000X	Marriage & Family Therapist	157075	CA

General Provider Information

NPI Number	:	1609734888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY BUITRAGO

Provider Business Mailing Address
First Line	:	12131 MAGNOLIA BLVD
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-5054
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 S FIGUEROA ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3422
Country	:	US
Telephone Number	:	213-765-9680
Fax Number	:

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ HAILEY BUITRAGO ” Practice Location

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