Healthcare Provider Details

I. General information

NPI: 1154777639
Provider Name (Legal Business Name): AMELIA BUENVENIDA DNP, FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 PALM AVE STE J2
SAN DIEGO CA
92154-1012
US

IV. Provider business mailing address

1729 WEBBER WAY
CHULA VISTA CA
91913-4372
US

V. Phone/Fax

Practice location:
  • Phone: 619-490-3112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95004301
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: