Provider Demographics
NPI:1669578241
Name:BUSH, GILBERT ALFORT (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:ALFORT
Last Name:BUSH
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
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Mailing Address - Street 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5360
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:754 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2544
Practice Address - Country:US
Practice Address - Phone:909-460-4155
Practice Address - Fax:909-988-4414
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
CAA328722083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA32872OtherMEDICAL LICENSE