Basic Information
| Provider Information | |||||||||
| NPI: | 1700189362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUHAY | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | CORNELIO | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2809 BAYWATER AVE | ||||||||
| Address2: | |||||||||
| City: | SAN PEDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907316643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107078878 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1701 CAMINO PALMERO ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900462902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238760550 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2010 | ||||||||
| LastUpdateDate: | 12/20/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 244232 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.