Healthcare Provider Details

I. General information

NPI: 1518214030
Provider Name (Legal Business Name): BRITTANY ANNE BUENO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 B ST
HAYWARD CA
94541-3020
US

IV. Provider business mailing address

5130 WILD CINNAMON DR
MELBOURNE FL
32940-1424
US

V. Phone/Fax

Practice location:
  • Phone: 510-582-4636
  • Fax:
Mailing address:
  • Phone: 321-266-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9346863
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: