Provider Demographics
NPI:1962282038
Name:BUISON, CARLA KHRISTINA (NP)
Entity type:Individual
Prefix:
First Name:CARLA KHRISTINA
Middle Name:
Last Name:BUISON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 DAINTY AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1205
Mailing Address - Country:US
Mailing Address - Phone:510-386-6136
Mailing Address - Fax:
Practice Address - Street 1:2455 SAND CREEK RD STE 144
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7176
Practice Address - Country:US
Practice Address - Phone:510-386-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027125363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner