Healthcare Provider Details

I. General information

NPI: 1780494955
Provider Name (Legal Business Name): JARELY BUENO-GARCIA AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N AVENUE 66
LOS ANGELES CA
90042-1508
US

IV. Provider business mailing address

4854 ELTON ST
BALDWIN PARK CA
91706-1906
US

V. Phone/Fax

Practice location:
  • Phone: 626-517-2368
  • Fax:
Mailing address:
  • Phone: 626-367-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT151103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: