Provider Demographics
NPI:1912911264
Name:BUSLON, MAGDALENA G (RNP)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:G
Last Name:BUSLON
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 INDEPENDENCE AVE APT 22
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-1719
Mailing Address - Country:US
Mailing Address - Phone:818-700-9870
Mailing Address - Fax:
Practice Address - Street 1:18111 NORDHOFF ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91330-8270
Practice Address - Country:US
Practice Address - Phone:818-677-3666
Practice Address - Fax:818-677-2304
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
CARN214913363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094830OtherMEDI-CAL/FPACT