1295086163 NPI number — MRS. ELENA JAKLIN BUDAGYAN PA-C

Table of content: MRS. ELENA JAKLIN BUDAGYAN PA-C (NPI 1295086163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295086163 NPI number — MRS. ELENA JAKLIN BUDAGYAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUDAGYAN
Provider First Name:
ELENA
Provider Middle Name:
JAKLIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295086163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10050 GARVEY AVE
Provider Second Line Business Mailing Address:
#111
Provider Business Mailing Address City Name:
EL MONTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91733-2088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-652-0790
Provider Business Mailing Address Fax Number:
626-652-0799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10050 GARVEY AVE
Provider Second Line Business Practice Location Address:
#111
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91733-2088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-652-0790
Provider Business Practice Location Address Fax Number:
626-652-0799
Provider Enumeration Date:
10/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA22502 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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