Provider Demographics
NPI:1508193913
Name:ENVAP BUENVIAJE-SMITH PC
Entity Type:Organization
Organization Name:ENVAP BUENVIAJE-SMITH PC
Other - Org Name:ENVAP BUENVIAJE-SMITH INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LIGON
Authorized Official - Last Name:BUENVIAJE-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-782-8540
Mailing Address - Street 1:16085 TUSCOLA RD STE 2AND3
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1358
Mailing Address - Country:US
Mailing Address - Phone:760-810-0301
Mailing Address - Fax:760-927-3256
Practice Address - Street 1:9090 MILLIKEN AVE STE 140
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5561
Practice Address - Country:US
Practice Address - Phone:909-481-8444
Practice Address - Fax:909-481-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACV074AMedicare PIN