Provider Demographics
NPI:1093058364
Name:MADRIAGA, BUENAVENTURA TABAYOYONG JR (RCP)
Entity Type:Individual
Prefix:MR
First Name:BUENAVENTURA
Middle Name:TABAYOYONG
Last Name:MADRIAGA
Suffix:JR
Gender:M
Credentials:RCP
Other - Prefix:MR
Other - First Name:DANNY
Other - Middle Name:
Other - Last Name:MADRIAGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RCP
Mailing Address - Street 1:8437 MAMMOTH AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3816
Mailing Address - Country:US
Mailing Address - Phone:818-687-9556
Mailing Address - Fax:
Practice Address - Street 1:13652 CANTARA ST # 109
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-375-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11911227800000X, 227900000X, 2279P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
No2279P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Function Technologist