Provider Demographics
NPI:1760443972
Name:BUENAVENTURA, RICARDO MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:MARIO
Last Name:BUENAVENTURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7244 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4207
Mailing Address - Country:US
Mailing Address - Phone:937-395-1300
Mailing Address - Fax:937-395-1311
Practice Address - Street 1:7244 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4207
Practice Address - Country:US
Practice Address - Phone:937-395-1300
Practice Address - Fax:937-395-1311
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069740208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2397188Medicaid
OHG92866Medicare UPIN
OH2397188Medicaid