Healthcare Provider Details

I. General information

NPI: 1497175046
Provider Name (Legal Business Name): LEON BUENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S L ST
DINUBA CA
93618-2323
US

IV. Provider business mailing address

144 S L ST
DINUBA CA
93618-2323
US

V. Phone/Fax

Practice location:
  • Phone: 559-591-6680
  • Fax: 559-591-6684
Mailing address:
  • Phone: 559-591-6680
  • Fax: 559-591-6684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number59546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: