Provider Demographics
NPI:1477712727
Name:BUISON, ROMEO GONZALES
Entity Type:Individual
Prefix:MR
First Name:ROMEO
Middle Name:GONZALES
Last Name:BUISON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROMEO
Other - Middle Name:GONZALES
Other - Last Name:BUISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:234 S FELDNER RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2716
Mailing Address - Country:US
Mailing Address - Phone:714-634-8780
Mailing Address - Fax:714-634-8780
Practice Address - Street 1:490 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-4806
Practice Address - Country:US
Practice Address - Phone:707-694-1845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH44829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist