Provider Demographics
NPI:1225779994
Name:BUENAVENTURA, CARA ISOBEL SANTIANO
Entity Type:Individual
Prefix:
First Name:CARA ISOBEL
Middle Name:SANTIANO
Last Name:BUENAVENTURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17154 INDEX ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4133
Mailing Address - Country:US
Mailing Address - Phone:818-203-0104
Mailing Address - Fax:
Practice Address - Street 1:8673 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2377
Practice Address - Country:US
Practice Address - Phone:310-652-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA61801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant