Healthcare Provider Details

I. General information

NPI: 1003788480
Provider Name (Legal Business Name): JULIE AGULIAR BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 S LOCUST ST
GRAND ISLAND NE
68801-8248
US

IV. Provider business mailing address

PO BOX 939
BELLEVUE NE
68005-0939
US

V. Phone/Fax

Practice location:
  • Phone: 402-699-4902
  • Fax:
Mailing address:
  • Phone: 308-223-1064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: