Provider Demographics
NPI:1922670504
Name:BUGARIN, ROBERTO JR
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:BUGARIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 PARK ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2462
Mailing Address - Country:US
Mailing Address - Phone:626-731-1049
Mailing Address - Fax:
Practice Address - Street 1:1335 PARK ROSE AVE
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2462
Practice Address - Country:US
Practice Address - Phone:626-731-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst