Provider Demographics
NPI:1609203900
Name:BUMATAY, FRAGRANCE (NP)
Entity Type:Individual
Prefix:
First Name:FRAGRANCE
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 1:7601 EAST IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3456
Mailing Address - Country:US
Mailing Address - Phone:562-401-6535
Mailing Address - Fax:562-401-6535
Practice Address - Street 1:4525 E ATHERTON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3700
Practice Address - Country:US
Practice Address - Phone:562-961-0155
Practice Address - Fax:562-961-0161
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA363LF0000X
CA23118363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty