Healthcare Provider Details

I. General information

NPI: 1548480742
Provider Name (Legal Business Name): RACQUEL SMITH BUENO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34503 9TH AVE S STE 220
FEDERAL WAY WA
98003-8726
US

IV. Provider business mailing address

722 N TACOMA AVE
TACOMA WA
98403-2831
US

V. Phone/Fax

Practice location:
  • Phone: 253-944-2080
  • Fax: 253-944-2099
Mailing address:
  • Phone: 808-561-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-12516
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD61356110
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: