Healthcare Provider Details

I. General information

NPI: 1922310127
Provider Name (Legal Business Name): MILAGROS TINIO BUENVIAJE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23275 EASTBROOK CT
LOS ALTOS CA
94024-6606
US

IV. Provider business mailing address

694 W DANA ST
MOUNTAIN VIEW CA
94041-1302
US

V. Phone/Fax

Practice location:
  • Phone: 650-988-0828
  • Fax: 650-988-0890
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA32312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: