Provider Demographics
NPI:1366859860
Name:BUENALUZ, PRIMROSE SEVESES
Entity Type:Individual
Prefix:MS
First Name:PRIMROSE
Middle Name:SEVESES
Last Name:BUENALUZ
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 1:1210 WILHELMINA RISE
Mailing Address - Street 2:UNIT B
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3287
Mailing Address - Country:US
Mailing Address - Phone:808-260-9056
Mailing Address - Fax:
Practice Address - Street 1:1210 WILHELMINA RISE
Practice Address - Street 2:UNIT B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3287
Practice Address - Country:US
Practice Address - Phone:808-260-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235Z00000X
HI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist