Provider Demographics
NPI:1972820082
Name:BUDMAN, COURTLAN
Entity type:Individual
Prefix:
First Name:COURTLAN
Middle Name:
Last Name:BUDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTLAN
Other - Middle Name:
Other - Last Name:MCCLINTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:8612 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-1509
Mailing Address - Country:US
Mailing Address - Phone:310-924-1729
Mailing Address - Fax:
Practice Address - Street 1:436 N BEDFORD DR STE 202
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4359
Practice Address - Country:US
Practice Address - Phone:310-271-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15309363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner