Healthcare Provider Details

I. General information

NPI: 1013038579
Provider Name (Legal Business Name): LEONIDA S BUENVIAJE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MORSE AVE SPC 37
SUNNYVALE CA
94089-1611
US

IV. Provider business mailing address

1111 MORSE AVE SPC 37
SUNNYVALE CA
94089-1611
US

V. Phone/Fax

Practice location:
  • Phone: 408-752-0998
  • Fax:
Mailing address:
  • Phone: 408-752-0998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number452576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: