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General NPI Number Information
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NPI Number | 1205039815
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Entity Type | Organization
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Legal Business Name | JAY KENNETH P BUENAFLOR MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/09/2007
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 608 G ST SUITE 1A
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City | BRAWLEY
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State | CA
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Zip | 92227-2568
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Country | US
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Telephone | 760-351-2127
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Fax |
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Provider Business Mailing Address
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Address Line | 608 G ST SUITE 1A
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City | BRAWLEY
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State | CA
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Zip | 92227-2568
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Country | US
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Telephone | 760-351-2127
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Fax |
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Authorized Official
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Title or Position | MD
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Name | JAY KENNETH P BUENFLOR
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Credential | MD
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Telephone | 760-344-7976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A82945
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License Number State | CA
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