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General NPI Number Information
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NPI Number | 1144952524
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Entity Type | Individual
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Provider Name | MARIELA BUENO
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Gender | Female
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Dates
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Enumeration Date | 06/25/2022
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1604 E 8TH ST STE A
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City | WESLACO
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State | TX
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Zip | 78596-5587
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Country | US
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Telephone | 956-630-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 36900 MILE 14 RD
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City | EDINBURG
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State | TX
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Zip | 78541-7429
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Country | US
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Telephone | 956-665-7049
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17685
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License Number State | TX
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