Provider Demographics
NPI:1568551547
Name:BUAN, THELMA VIERNES (MD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:VIERNES
Last Name:BUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:123 N GARFIELD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3564
Mailing Address - Country:US
Mailing Address - Phone:626-308-3781
Mailing Address - Fax:626-308-2113
Practice Address - Street 1:123 N GARFIELD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3564
Practice Address - Country:US
Practice Address - Phone:626-308-3781
Practice Address - Fax:626-308-2113
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA34218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A342181Medicaid
CAWA34218HMedicare PIN
CAA84588Medicare UPIN