Healthcare Provider Details

I. General information

NPI: 1285184457
Provider Name (Legal Business Name): BUENAVENTURA AFFILIATED PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 INDIANA AVE SUITE 110
RIVERSIDE CA
92506-4270
US

IV. Provider business mailing address

3900 KILROY AIRPORT WAY STE 110
LONG BEACH CA
90806-6809
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-1622
  • Fax: 951-682-5902
Mailing address:
  • Phone: 562-888-1415
  • Fax: 562-424-1826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE BUI
Title or Position: ADMINISTRTOR
Credential:
Phone: 562-888-1415