Healthcare Provider Details

I. General information

NPI: 1518696319
Provider Name (Legal Business Name): WENDY BERENICE BUZO PEREZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY BERENICE CASTLE

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E BIRCH ST
CALEXICO CA
92231
US

IV. Provider business mailing address

74 W CORRELL RD
HEBER CA
92249-9644
US

V. Phone/Fax

Practice location:
  • Phone: 760-890-5593
  • Fax:
Mailing address:
  • Phone: 760-554-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: