Provider Demographics
NPI:1467930875
Name:RELIABLE CARE MD ON THE GO
Entity Type:Organization
Organization Name:RELIABLE CARE MD ON THE GO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUENVENIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-718-1743
Mailing Address - Street 1:4565 RUFFNER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2259
Mailing Address - Country:US
Mailing Address - Phone:619-718-1743
Mailing Address - Fax:
Practice Address - Street 1:4565 RUFFNER ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2259
Practice Address - Country:US
Practice Address - Phone:619-718-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIABLE CARE MD ON THE GO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty