Provider Demographics
NPI:1568188233
Name:BUESO, SERGIO DAVID
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:DAVID
Last Name:BUESO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 CASA MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-1637
Mailing Address - Country:US
Mailing Address - Phone:832-291-7226
Mailing Address - Fax:
Practice Address - Street 1:5426 CASA MARTIN DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-1637
Practice Address - Country:US
Practice Address - Phone:832-291-7226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171M00000XOtherCOMPANY