Basic Information
| Provider Information | |||||||||
| NPI: | 1023764057 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUFORD | ||||||||
| FirstName: | KENYATTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 E MOBECK ST APT A | ||||||||
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| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917906708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265499970 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2008 N GAREY AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917672722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096236131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2022 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW106197 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.