Provider Demographics
NPI:1205039815
Name:JAY KENNETH P BUENAFLOR MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JAY KENNETH P BUENAFLOR MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAY KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUENFLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-344-7976
Mailing Address - Street 1:608 G ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2568
Mailing Address - Country:US
Mailing Address - Phone:760-351-2127
Mailing Address - Fax:
Practice Address - Street 1:608 G ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2568
Practice Address - Country:US
Practice Address - Phone:760-351-2127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-09
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82945208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A829450Medicaid
CA00A829450Medicaid