Healthcare Provider Details

I. General information

NPI: 1558079889
Provider Name (Legal Business Name): ISABELLA MARYSE BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8467 PRIMULA CIR
BUENA PARK CA
90620-2158
US

IV. Provider business mailing address

8467 PRIMULA CIR
BUENA PARK CA
90620-2158
US

V. Phone/Fax

Practice location:
  • Phone: 714-366-4388
  • Fax:
Mailing address:
  • Phone: 714-366-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: