Healthcare Provider Details

I. General information

NPI: 1548223225
Provider Name (Legal Business Name): RAMON V BUENAVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 E BASELINE RD SUITE 103
MESA AZ
85204-7290
US

IV. Provider business mailing address

3130 E BASELINE RD SUITE 103
MESA AZ
85204-7290
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-1252
  • Fax: 602-867-1256
Mailing address:
  • Phone: 602-867-1252
  • Fax: 602-867-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5749
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: