Provider Demographics
NPI:1285054445
Name:BUENO, ENRIQUE (CONTRACTOR GENERAL)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:BUENO
Suffix:
Gender:M
Credentials:CONTRACTOR GENERAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8052 GROUSE RUN DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-9256
Mailing Address - Country:US
Mailing Address - Phone:575-202-6972
Mailing Address - Fax:575-526-4835
Practice Address - Street 1:8052 GROUSE RUN DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-9256
Practice Address - Country:US
Practice Address - Phone:575-202-6972
Practice Address - Fax:575-526-4835
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM054569171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1285054445OtherE AND E CONSTRUCTION CO.
NM55076823Medicaid