Provider Demographics
NPI:1497704381
Name:BUNO-BRION, IRENE J (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:J
Last Name:BUNO-BRION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:J
Other - Last Name:BUNO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 130580
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92013-0580
Mailing Address - Country:US
Mailing Address - Phone:760-710-1025
Mailing Address - Fax:
Practice Address - Street 1:400 CRAVEN RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4201
Practice Address - Country:US
Practice Address - Phone:800-290-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83987207N00000X
WAMD00036768207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA159258OtherLABOR & INDUSTRIES
1153BUOtherREGENCE BLUESHIELD
WA8239014Medicaid
070016744OtherRAILROAD MEDICARE
7176003OtherAETNA
7176003OtherAETNA
BB5404354OtherDEA
070016744OtherRAILROAD MEDICARE
G8890363Medicare PIN
1153BUOtherREGENCE BLUESHIELD
WA8239014Medicaid
WAGAB28247Medicare PIN
7176003OtherAETNA
G60328Medicare UPIN
WAGAB28250Medicare PIN