Healthcare Provider Details

I. General information

NPI: 1043087828
Provider Name (Legal Business Name): BUITRON BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6669 N EXETER LN APT 103
MERIDIAN ID
83646-1582
US

IV. Provider business mailing address

PO BOX 1658
MERIDIAN ID
83680-1658
US

V. Phone/Fax

Practice location:
  • Phone: 951-392-0237
  • Fax:
Mailing address:
  • Phone: 951-392-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VANESSA RUBY FUENTES
Title or Position: OWNER
Credential:
Phone: 951-392-0237