Basic Information
| Provider Information | |||||||||
| NPI: | 1871013474 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUENROSTRO CONTRERAS | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | RAUL | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 15TH ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948013683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156865687 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3282 ADELINE ST | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947032439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109815280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2017 | ||||||||
| LastUpdateDate: | 01/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.