Provider Demographics
NPI:1679149140
Name:BUENAVIDES, MARIE SUSAN CABREROS
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:SUSAN CABREROS
Last Name:BUENAVIDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 BECKETT CENTER DR STE 304
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5027
Mailing Address - Country:US
Mailing Address - Phone:513-500-2500
Mailing Address - Fax:
Practice Address - Street 1:8050 BECKETT CENTER DR STE 304
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5027
Practice Address - Country:US
Practice Address - Phone:513-500-2500
Practice Address - Fax:513-847-4882
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0093545376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093545Medicaid