Healthcare Provider Details

I. General information

NPI: 1902719495
Provider Name (Legal Business Name): FRENNESY YAMILEX BUENAVISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 N AVENUE 54
LOS ANGELES CA
90042-2424
US

IV. Provider business mailing address

626 N AVENUE 54
LOS ANGELES CA
90042-2424
US

V. Phone/Fax

Practice location:
  • Phone: 323-506-1708
  • Fax: 323-506-1708
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: