=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508193913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENVAP BUENVIAJE-SMITH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2009
-----------------------------------------------------
Last Update Date | 05/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9090 MILLIKEN AVE STE 140
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-5561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-481-8444
-----------------------------------------------------
Fax | 909-481-8447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16085 TUSCOLA RD STE 2AND3
-----------------------------------------------------
City | APPLE VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92307-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-810-0301
-----------------------------------------------------
Fax | 760-927-3256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SARAH LIGON BUENVIAJE-SMITH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 909-782-8540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------