Provider Demographics
NPI:1063873651
Name:BUAN, WARREN
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:BUAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ADAMS AVE APT 16L
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-8318
Mailing Address - Country:US
Mailing Address - Phone:949-590-7029
Mailing Address - Fax:
Practice Address - Street 1:1300 ADAMS AVE APT 16L
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-8318
Practice Address - Country:US
Practice Address - Phone:949-590-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034084225100000X
WAPT60408466225100000X
CA292087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist