Healthcare Provider Details

I. General information

NPI: 1780878819
Provider Name (Legal Business Name): LIDIA CRISTINA BUENO PH.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIDIA DE LEON

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 07/10/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 N 1ST ST STE 228
SAN JOSE CA
95112-5365
US

IV. Provider business mailing address

PO BOX 28201
SAN JOSE CA
95159-8201
US

V. Phone/Fax

Practice location:
  • Phone: 408-596-6862
  • Fax:
Mailing address:
  • Phone: 408-596-6862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number54049
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number50042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: