Basic Information
| Provider Information | |||||||||
| NPI: | 1295086163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUDAGYAN | ||||||||
| FirstName: | ELENA | ||||||||
| MiddleName: | JAKLIN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10050 GARVEY AVE | ||||||||
| Address2: | #111 | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917332088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266520790 | ||||||||
| FaxNumber: | 6266520799 | ||||||||
| Practice Location | |||||||||
| Address1: | 10050 GARVEY AVE | ||||||||
| Address2: | #111 | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917332088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266520790 | ||||||||
| FaxNumber: | 6266520799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2012 | ||||||||
| LastUpdateDate: | 10/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA22502 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.