Healthcare Provider Details

I. General information

NPI: 1245573039
Provider Name (Legal Business Name): KRISTEN BUONO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 10/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CITY BLVD W STE 1400
ORANGE CA
92868-5900
US

IV. Provider business mailing address

333 CITY BLVD W STE 1400
ORANGE CA
92868-5900
US

V. Phone/Fax

Practice location:
  • Phone: 619-339-6630
  • Fax:
Mailing address:
  • Phone: 619-339-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA131712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: