Healthcare Provider Details

I. General information

NPI: 1235309626
Provider Name (Legal Business Name): MARIBEL BUENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W MINTHORN ST
LAKE ELSINORE CA
92530-2808
US

IV. Provider business mailing address

1400 W MINTHORN ST
LAKE ELSINORE CA
92530-2808
US

V. Phone/Fax

Practice location:
  • Phone: 951-245-3210
  • Fax:
Mailing address:
  • Phone: 951-245-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7957-R
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: