Provider Demographics
NPI:1306586375
Name:BUENO, MITSU KAORY (DO)
Entity type:Individual
Prefix:
First Name:MITSU
Middle Name:KAORY
Last Name:BUENO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3001
Mailing Address - Country:US
Mailing Address - Phone:786-381-3045
Mailing Address - Fax:
Practice Address - Street 1:637 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3001
Practice Address - Country:US
Practice Address - Phone:786-381-3045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program