Healthcare Provider Details

I. General information

NPI: 1053586990
Provider Name (Legal Business Name): MAURICIO AUGUSTO BUENDIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N KROME AVE 202
HOMESTEAD FL
33030-4400
US

IV. Provider business mailing address

P O BOX 901650
HOMESTEAD FL
33090
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-3888
  • Fax: 305-674-3388
Mailing address:
  • Phone: 305-674-3888
  • Fax: 305-674-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME101095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: