MEDICARE: BRENDA BUITRON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1548985682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA BUITRON

Provider Business Mailing Address
First Line	:	1330 N INDIAN CANYON DR STE A
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4880
Country	:	US
Telephone Number	:	909-462-7436
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 N INDIAN CANYON DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4880
Country	:	US
Telephone Number	:	909-462-7436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	02/16/2026

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Directions to “ BRENDA BUITRON ” Practice Location

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