Healthcare Provider Details

I. General information

NPI: 1336955400
Provider Name (Legal Business Name): SEAN PATRICK A. BUENAFLOR CHW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 S EASTERN AVENUE
LAS VEGAS NV
89169
US

IV. Provider business mailing address

8936 SPANISH RIDGE AVENUE
LAS VEGAS NV
89148
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-0909
  • Fax: 702-731-1020
Mailing address:
  • Phone: 702-731-0909
  • Fax: 702-998-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW1-5460
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: