Healthcare Provider Details

I. General information

NPI: 1023077492
Provider Name (Legal Business Name): ANGELITA DOMINGO BUENO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD
HARBOR CITY CA
90710-2076
US

IV. Provider business mailing address

325 PALM CT
CARSON CA
90745-3100
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-5800
  • Fax: 310-530-9811
Mailing address:
  • Phone: 310-835-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP12567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: