Healthcare Provider Details

I. General information

NPI: 1679215115
Provider Name (Legal Business Name): BRIANA BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 S 9TH ST 1417 S 9TH ST
MCALESTER OK
74501-7001
US

IV. Provider business mailing address

727 E WYANDOTTE AVE
MCALESTER OK
74501-5427
US

V. Phone/Fax

Practice location:
  • Phone: 918-470-4533
  • Fax:
Mailing address:
  • Phone: 918-470-4533
  • 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: