Provider Demographics
NPI:1285816553
Name:CONTRERAS-BUENO, VICENTE
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:
Last Name:CONTRERAS-BUENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 CORTE VIS APT 84
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-4126
Mailing Address - Country:US
Mailing Address - Phone:619-941-2613
Mailing Address - Fax:
Practice Address - Street 1:10174 OLD GROVE RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1652
Practice Address - Country:US
Practice Address - Phone:619-876-9945
Practice Address - Fax:619-281-3714
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CARBT-17-38170106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor