Individual
IMAWATI BUDIHARDJO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., PH.D
Contact information
Practice address
3855 HEALTH SCIENCES DR # 0658, LA JOLLA, CA 92093-0987
(858) 822-6100
(858) 822-6186
Mailing address
3855 HEALTH SCIENCES DRIVE, ROOM 2016, LA JOLLA, CA 92093-0698
(858) 822-7916
(858) 822-5380
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
A84421
CA
Other
Enumeration date
03/23/2007
Last updated
10/12/2007
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