Healthcare Provider Details

I. General information

NPI: 1760443972
Provider Name (Legal Business Name): RICARDO MARIO BUENAVENTURA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7244 FAR HILLS AVE
CENTERVILLE OH
45459-4207
US

IV. Provider business mailing address

7244 FAR HILLS AVE
CENTERVILLE OH
45459-4207
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-1300
  • Fax: 937-395-1311
Mailing address:
  • Phone: 937-395-1300
  • Fax: 937-395-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35069740
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: