Provider Demographics
NPI:1245606672
Name:BUMATAY, JAMILIE (NP)
Entity Type:Individual
Prefix:MS
First Name:JAMILIE
Middle Name:
Last Name:BUMATAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 LINCOLN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4232
Mailing Address - Country:US
Mailing Address - Phone:714-222-3321
Mailing Address - Fax:
Practice Address - Street 1:813 LINCOLN GLEN DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4232
Practice Address - Country:US
Practice Address - Phone:714-222-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily