Provider Demographics
NPI:1427010784
Name:BUAN, DEANA MICHELLE DODD (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:MICHELLE DODD
Last Name:BUAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DEANA
Other - Middle Name:MICHELLE
Other - Last Name:DODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:27483 PAPER BARK AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2536
Mailing Address - Country:US
Mailing Address - Phone:951-816-4268
Mailing Address - Fax:714-935-0075
Practice Address - Street 1:41880 KALMIA ST. SUITE 100
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:951-696-7587
Practice Address - Fax:951-461-6973
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPZ18052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant