Provider Demographics
NPI:1932113222
Name:BUSA HUSON, PAULINE ROSE (DPM)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:ROSE
Last Name:BUSA HUSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:ROSE
Other - Last Name:BUSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3071 COLLEGE GREEN DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3204
Mailing Address - Country:US
Mailing Address - Phone:209-723-6800
Mailing Address - Fax:209-723-4333
Practice Address - Street 1:3071 COLLEGE GREEN DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3204
Practice Address - Country:US
Practice Address - Phone:209-723-6800
Practice Address - Fax:209-723-4333
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3223213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E32230Medicare ID - Type Unspecified
T11585Medicare UPIN