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Organization
W. RICHARD BUKATA
Active
Organization
W. RICHARD BUKATA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA MCMANN (BUSINESS ANALYST)
(509) 535-4370
Entity
Organization
Contact information
Practice address
438 W LAS TUNAS DR, SAN GABRIEL, CA 91776-1216
(626) 289-5454
Mailing address
FILE 57430, LOS ANGELES, CA 90074-7430
(800) 819-2424
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G26036
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G260360
BLUE SHIELD
—
05
—
00G260360
—
CA
01
—
G26036
CA BLUE CROSS
—
Enumeration date
05/17/2007
Last updated
08/22/2020
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