Healthcare Provider Details

I. General information

NPI: 1508193913
Provider Name (Legal Business Name): ENVAP BUENVIAJE-SMITH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9090 MILLIKEN AVE STE 140
RANCHO CUCAMONGA CA
91730-5561
US

IV. Provider business mailing address

16085 TUSCOLA RD STE 2AND3
APPLE VALLEY CA
92307-1358
US

V. Phone/Fax

Practice location:
  • Phone: 909-481-8444
  • Fax: 909-481-8447
Mailing address:
  • Phone: 760-810-0301
  • Fax: 760-927-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH LIGON BUENVIAJE-SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 909-782-8540