Individual
MARCELLA BUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HEALTH CARE ADMINIST
Contact information
Practice address
14050 PEARL ST, HESPERIA, CA 92344-8096
(330) 328-2114
(760) 533-9300
Mailing address
14050 PEARL ST, HESPERIA, CA 92344-8096
(330) 328-2114
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
463952905
NON PROFIT
CA
05
—
463952905
—
CA
Enumeration date
12/15/2017
Last updated
12/15/2017
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