Healthcare Provider Details

I. General information

NPI: 1194400739
Provider Name (Legal Business Name): ADRIANA BUENAVENTURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIANA CASAS

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E 2ND ST STE 7
POMONA CA
91766-2007
US

IV. Provider business mailing address

795 E 2ND ST STE 7
POMONA CA
91766-2007
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-2565
  • Fax: 909-865-2955
Mailing address:
  • Phone: 909-865-2565
  • Fax: 909-865-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL7117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: