Provider Demographics
NPI:1235453754
Name:GADSON, BULEAH MAE (PA)
Entity Type:Individual
Prefix:MS
First Name:BULEAH
Middle Name:MAE
Last Name:GADSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6861 VIA IRANA
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-1922
Mailing Address - Country:US
Mailing Address - Phone:714-654-3858
Mailing Address - Fax:
Practice Address - Street 1:1723 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5502
Practice Address - Country:US
Practice Address - Phone:714-635-0363
Practice Address - Fax:714-772-2994
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant