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General NPI Number Information
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NPI Number | 1760443972
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Entity Type | Individual
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Provider Name | RICARDO MARIO BUENAVENTURA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 7244 FAR HILLS AVE
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City | CENTERVILLE
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State | OH
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Zip | 45459-4207
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Country | US
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Telephone | 937-395-1300
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Fax | 937-395-1311
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Provider Business Mailing Address
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Address Line | 7244 FAR HILLS AVE
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City | CENTERVILLE
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State | OH
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Zip | 45459-4207
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Country | US
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Telephone | 937-395-1300
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Fax | 937-395-1311
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 35069740
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License Number State | OH
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