Healthcare Provider Details

I. General information

NPI: 1205039815
Provider Name (Legal Business Name): JAY KENNETH P BUENAFLOR MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 G ST SUITE 1A
BRAWLEY CA
92227-2568
US

IV. Provider business mailing address

608 G ST SUITE 1A
BRAWLEY CA
92227-2568
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-2127
  • Fax:
Mailing address:
  • Phone: 760-351-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA82945
License Number StateCA

VIII. Authorized Official

Name: JAY KENNETH P BUENFLOR
Title or Position: MD
Credential: MD
Phone: 760-344-7976