Healthcare Provider Details

I. General information

NPI: 1235067224
Provider Name (Legal Business Name): MARVIN WAYNE BUXTON II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WAYNE BUXTON II

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 48TH ST
SACRAMENTO CA
95817-1541
US

IV. Provider business mailing address

180 ROSALIE DR
GRAND JUNCTION CO
81503-2237
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: