Provider Demographics
NPI:1902799760
Name:BUAN, MARGARITA DIAZ (PTA)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:DIAZ
Last Name:BUAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:DIAZ
Other - Last Name:BUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1136 N COLUMBUS AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2373
Mailing Address - Country:US
Mailing Address - Phone:253-228-2578
Mailing Address - Fax:
Practice Address - Street 1:4867 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5969
Practice Address - Country:US
Practice Address - Phone:253-228-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51969225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant