Healthcare Provider Details

I. General information

NPI: 1790696805
Provider Name (Legal Business Name): JOHN BUONO MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 3RD AVE APT 1404
SAN DIEGO CA
92103-1574
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 718-702-4816
  • Fax:
Mailing address:
  • Phone: 877-747-5050
  • Fax: 775-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN BUONO
Title or Position: OWNER
Credential: MD
Phone: 718-702-4816