Healthcare Provider Details

I. General information

NPI: 1760156798
Provider Name (Legal Business Name): ISABEL BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 KEARNY VILLA RD STE 500
SAN DIEGO CA
92123-1953
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5016
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: