Healthcare Provider Details

I. General information

NPI: 1386660579
Provider Name (Legal Business Name): PHILIP NARCISO BUENVENIDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34617 11TH PL S STE 204
FEDERAL WAY WA
98003-8706
US

IV. Provider business mailing address

34617 11TH PL S STE 204
FEDERAL WAY WA
98003-8706
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-8445
  • Fax: 253-874-2085
Mailing address:
  • Phone: 253-874-8445
  • Fax: 253-874-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00022337
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: