Healthcare Provider Details

I. General information

NPI: 1417094277
Provider Name (Legal Business Name): GENEVIEVE B BUENAFLOR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9089 BASELINE RD SUITE 100
RANCHO CUCAMONGA CA
91730-1295
US

IV. Provider business mailing address

9089 BASELINE RD SUITE 100
RANCHO CUCAMONGA CA
91730-1295
US

V. Phone/Fax

Practice location:
  • Phone: 909-464-9675
  • Fax:
Mailing address:
  • Phone: 909-464-9675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A11320
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: