Basic Information
| Provider Information | |||||||||
| NPI: | 1578057576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUENO | ||||||||
| FirstName: | JOANA RUBY | ||||||||
| MiddleName: | CALLANTA | ||||||||
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| Credential: | MSN, CRNP, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 232410 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921932410 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 W ARBOR DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921039000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009268273 | ||||||||
| FaxNumber: | 8885398781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2018 | ||||||||
| LastUpdateDate: | 10/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | SP019733 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 95010538 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 95010538 | 01 | CA | CA BOARD OF REGISTERED NURSING | OTHER | SP019733 | 01 | PA | PA STATE BOARD OF NURSING | OTHER |