Healthcare Provider Details

I. General information

NPI: 1821930967
Provider Name (Legal Business Name): THERESE LOGARTA BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 N BROADWAY # 10701
YONKERS NY
10701-1301
US

IV. Provider business mailing address

7842 KEYSTONE RD
ORLAND PARK IL
60462-5097
US

V. Phone/Fax

Practice location:
  • Phone: 914-964-4444
  • Fax:
Mailing address:
  • Phone: 708-444-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: