Healthcare Provider Details

I. General information

NPI: 1215841036
Provider Name (Legal Business Name): CRISTOBAL BUENROSTRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 W 19TH ST APT 9
LONG BEACH CA
90810-4109
US

IV. Provider business mailing address

1336 W 19TH ST APT 9
LONG BEACH CA
90810-4109
US

V. Phone/Fax

Practice location:
  • Phone: 562-619-9768
  • Fax:
Mailing address:
  • Phone: 562-619-9768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95387028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: