Healthcare Provider Details

I. General information

NPI: 1710373857
Provider Name (Legal Business Name): VANESSA BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S MYRTLE AVE STE 100
MONROVIA CA
91016
US

IV. Provider business mailing address

612 S MYRTLE AVE STE 100
MONROVIA CA
91016-3406
US

V. Phone/Fax

Practice location:
  • Phone: 626-775-7888
  • Fax:
Mailing address:
  • Phone: 626-775-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: