Individual
MR. LEO BORISOVICH BUGAEFF I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC/RN
Contact information
Practice address
4643 DOCK RD BLDG 524, PORT HUENEME, CA 93043-4378
(805) 982-2464
Mailing address
4643 DOCK RD BLDG 524, PORT HUENEME, CA 93043-4321
(805) 982-2464
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/04/2007
Last updated
10/04/2007
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