Provider Demographics
NPI:1336989466
Name:MARION, FLORA MAY BUGO
Entity type:Individual
Prefix:
First Name:FLORA MAY
Middle Name:BUGO
Last Name:MARION
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 1:9760 JERSEY AVE APT 174
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3165
Mailing Address - Country:US
Mailing Address - Phone:714-467-5056
Mailing Address - Fax:
Practice Address - Street 1:9760 JERSEY AVE APT 174
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3165
Practice Address - Country:US
Practice Address - Phone:714-467-5056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028048363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care