Provider Demographics
NPI:1376128686
Name:SAN BUENAVENTURA, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:SAN 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 1:178 ONONDAGA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3254
Mailing Address - Country:US
Mailing Address - Phone:415-312-5424
Mailing Address - Fax:
Practice Address - Street 1:3680 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-6500
Practice Address - Country:US
Practice Address - Phone:916-373-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist