Healthcare Provider Details

I. General information

NPI: 1124557160
Provider Name (Legal Business Name): ABEL BUENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 S JONES BLVD STE 206B
LAS VEGAS NV
89146-3103
US

IV. Provider business mailing address

6140 CARLSBAD AVE
LAS VEGAS NV
89156-5847
US

V. Phone/Fax

Practice location:
  • Phone: 702-496-1367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: