Healthcare Provider Details

I. General information

NPI: 1922079375
Provider Name (Legal Business Name): SARAH LIGON BUENVIAJE-SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16085 TUSCOLA RD SUITE 2 AND 3
APPLE VALLEY CA
92307-1358
US

IV. Provider business mailing address

16085 TUSCOLA RD SUITE 2 AND 3
APPLE VALLEY CA
92307-1358
US

V. Phone/Fax

Practice location:
  • Phone: 760-810-0301
  • Fax: 760-927-8885
Mailing address:
  • Phone: 760-810-0301
  • Fax: 760-927-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11504
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC52647
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberC52647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: