Provider Demographics
NPI:1285226399
Name:AMELIA BUENVENIDA FNP LLC
Entity Type:Organization
Organization Name:AMELIA BUENVENIDA FNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUENVENIDA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:619-201-3858
Mailing Address - Street 1:1729 WEBBER WAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-4372
Mailing Address - Country:US
Mailing Address - Phone:619-201-3858
Mailing Address - Fax:
Practice Address - Street 1:1729 WEBBER WAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-4372
Practice Address - Country:US
Practice Address - Phone:619-201-3858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty