Provider Demographics
NPI:1356664791
Name:BUCZKO, JOSEPHINE ANN (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:ANN
Last Name:BUCZKO
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 MARIANNA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2748
Mailing Address - Country:US
Mailing Address - Phone:323-255-8664
Mailing Address - Fax:
Practice Address - Street 1:1570 E COLORADO BLVD
Practice Address - Street 2:U-104
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2003
Practice Address - Country:US
Practice Address - Phone:626-585-7110
Practice Address - Fax:626-585-7933
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247876363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health