Provider Demographics
NPI:1720533995
Name:SAN BUENAVENTURA, MARIBEL (RN)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:SAN BUENAVENTURA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 TOSSA DE MAR AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-6535
Mailing Address - Country:US
Mailing Address - Phone:702-750-9259
Mailing Address - Fax:702-750-9259
Practice Address - Street 1:774 TOSSA DE MAR AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-6535
Practice Address - Country:US
Practice Address - Phone:702-750-9259
Practice Address - Fax:702-750-9259
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN73981163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical