Healthcare Provider Details

I. General information

NPI: 1154246783
Provider Name (Legal Business Name): AILEEN TIONGCO BUENAVENTURA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AILEEN BUENAVENTURA FABIAN

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CHESTNUT AVE
LONG BEACH CA
90813-2945
US

IV. Provider business mailing address

2360 W CANOPY LN
ANAHEIM CA
92801-5150
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-1565
  • Fax:
Mailing address:
  • Phone: 714-858-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: