Healthcare Provider Details

I. General information

NPI: 1518432111
Provider Name (Legal Business Name): JULIO BUENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S LEMAY AVE STE 35
FORT COLLINS CO
80525-2296
US

IV. Provider business mailing address

2601 S LEMAY AVE STE 35
FORT COLLINS CO
80525-2296
US

V. Phone/Fax

Practice location:
  • Phone: 970-682-2038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: