Healthcare Provider Details

I. General information

NPI: 1194648683
Provider Name (Legal Business Name): JOSE ENRIQUE BIEN LELIS BUENVIAJE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W KIMBERLY AVE STE 120
PLACENTIA CA
92870-6345
US

IV. Provider business mailing address

25910 ACERO STE 160
MISSION VIEJO CA
92691-2777
US

V. Phone/Fax

Practice location:
  • Phone: 877-527-7227
  • Fax:
Mailing address:
  • Phone: 877-527-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: