Healthcare Provider Details

I. General information

NPI: 1801689898
Provider Name (Legal Business Name): BUENO CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 S ORLANDO DR STE 130
SANFORD FL
32773-4106
US

IV. Provider business mailing address

2921 S ORLANDO DR STE 130
SANFORD FL
32773-4106
US

V. Phone/Fax

Practice location:
  • Phone: 321-285-9907
  • Fax:
Mailing address:
  • Phone: 321-285-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY J MALDONADO
Title or Position: CEO
Credential: PHARMD
Phone: 321-285-9907