Provider Demographics
NPI:1811146202
Name:BUGARIN, MICHELLE MADRIGAL
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MADRIGAL
Last Name:BUGARIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E WALNUT ST
Mailing Address - Street 2:ROOM 200
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1580
Mailing Address - Country:US
Mailing Address - Phone:626-356-5311
Mailing Address - Fax:626-568-9461
Practice Address - Street 1:300 E WALNUT ST
Practice Address - Street 2:ROOM 200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1580
Practice Address - Country:US
Practice Address - Phone:626-356-5311
Practice Address - Fax:626-568-9461
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA9284191171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator