Basic Information
| Provider Information | |||||||||
| NPI: | 1649623851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUENVIAJE | ||||||||
| FirstName: | PATRICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2009 SLAYTON ST | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935515408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613175234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2720 E PALMDALE BLVD | ||||||||
| Address2: | #128 | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935504930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619473333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2016 | ||||||||
| LastUpdateDate: | 07/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 278140 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.