Basic Information
Provider Information | |||||||||
NPI: | 1588856843 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BUENAFLOR | ||||||||
FirstName: | MARIA CHRISTINA | ||||||||
MiddleName: | SUNIO | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5959 S SHERWOOD FOREST BLVD | ||||||||
Address2: |   | ||||||||
City: | BATON ROUGE | ||||||||
State: | LA | ||||||||
PostalCode: | 708166038 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2255260002 | ||||||||
FaxNumber: | 2257659196 | ||||||||
Practice Location | |||||||||
Address1: | 420 AVENUE F | ||||||||
Address2: |   | ||||||||
City: | BOGALUSA | ||||||||
State: | LA | ||||||||
PostalCode: | 704273634 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9857307001 | ||||||||
FaxNumber: | 9857307006 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/10/2007 | ||||||||
LastUpdateDate: | 01/26/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/26/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD.204114 | LA | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | MD.204114 | 01 | LA | LSBME | OTHER | 1507997 | 05 | LA |   | MEDICAID |