Healthcare Provider Details

I. General information

NPI: 1760715668
Provider Name (Legal Business Name): JAMES JOSE BUENAVENTURA D.P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26640 WESTERN AVE SUITE L
HARBOR CITY CA
90710-3600
US

IV. Provider business mailing address

26640 WESTERN AVE SUITE L
HARBOR CITY CA
90710-3600
US

V. Phone/Fax

Practice location:
  • Phone: 310-530-3163
  • Fax: 562-393-4443
Mailing address:
  • Phone: 310-530-3163
  • Fax: 562-393-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: