Provider Demographics
NPI:1386660579
Name:BUENVENIDA, PHILIP NARCISO (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:NARCISO
Last Name:BUENVENIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34617 11TH PL S STE 104
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8706
Mailing Address - Country:US
Mailing Address - Phone:253-874-8445
Mailing Address - Fax:253-874-2085
Practice Address - Street 1:34617 11TH PL S STE 104
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8706
Practice Address - Country:US
Practice Address - Phone:253-874-8445
Practice Address - Fax:253-874-2085
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA78051OtherLABOR AND INDUSTRY
WA1050640Medicaid
BU8884OtherREGENCE
MD00022337OtherSTATE LICENSE
MD00022337OtherSTATE LICENSE
A16541Medicare UPIN