Healthcare Provider Details

I. General information

NPI: 1174446553
Provider Name (Legal Business Name): CHRISTIAN B BUENAVENTURA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S PRESTON AVE
BRYAN TX
77803-4062
US

IV. Provider business mailing address

107 S PRESTON AVE
BRYAN TX
77803-4062
US

V. Phone/Fax

Practice location:
  • Phone: 808-829-2450
  • Fax:
Mailing address:
  • Phone: 808-829-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number205886
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: