Healthcare Provider Details

I. General information

NPI: 1245125749
Provider Name (Legal Business Name): CAITLIN ANNE BUENAVENTURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 PIERCE ST STE 200
RIVERSIDE CA
92505-4400
US

IV. Provider business mailing address

3200 E GUASTI RD STE 100
ONTARIO CA
91761-8661
US

V. Phone/Fax

Practice location:
  • Phone: 714-267-9310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: