Healthcare Provider Details

I. General information

NPI: 1366239634
Provider Name (Legal Business Name): JAYROLD KEENE BUENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 LIGHTHOUSE AVE
MONTEREY CA
93940-1008
US

IV. Provider business mailing address

338 SAN LUIS AVE
WATSONVILLE CA
95076-6699
US

V. Phone/Fax

Practice location:
  • Phone: 831-655-5411
  • Fax:
Mailing address:
  • Phone: 831-247-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: