Provider Demographics
NPI:1386730760
Name:BUENO, JOSE BENAVIDEZ (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:BENAVIDEZ
Last Name:BUENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19273 KAMBRIDGE STREET
Mailing Address - Street 2:APPLE VALLEY
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308
Mailing Address - Country:US
Mailing Address - Phone:760-912-1613
Mailing Address - Fax:
Practice Address - Street 1:19273 KANBRIDGE ST
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-6071
Practice Address - Country:US
Practice Address - Phone:760-912-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO019480207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine