Provider Demographics
NPI:1760715668
Name:BUENAVENTURA, JAMES JOSE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSE
Last Name:BUENAVENTURA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:26640 WESTERN AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3600
Mailing Address - Country:US
Mailing Address - Phone:310-530-3163
Mailing Address - Fax:562-393-4443
Practice Address - Street 1:26640 WESTERN AVE
Practice Address - Street 2:SUITE L
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3600
Practice Address - Country:US
Practice Address - Phone:310-530-3163
Practice Address - Fax:562-393-4443
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist