Provider Demographics
NPI:1609204783
Name:BUENVIAJE, MARILOU ABARQUEZ
Entity Type:Individual
Prefix:MS
First Name:MARILOU
Middle Name:ABARQUEZ
Last Name:BUENVIAJE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARILOU
Other - Middle Name:ABARQUEZ
Other - Last Name:BUENVIAJE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:300 VAN PELT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2435
Mailing Address - Country:US
Mailing Address - Phone:718-720-5904
Mailing Address - Fax:
Practice Address - Street 1:300 VAN PELT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2435
Practice Address - Country:US
Practice Address - Phone:718-720-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health