Provider Demographics
NPI:1851758981
Name:BUENAVENTURA, STEPHANIE GARCIA (CNS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GARCIA
Last Name:BUENAVENTURA
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14958 BURROWS WAY
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-4503
Mailing Address - Country:US
Mailing Address - Phone:951-317-9917
Mailing Address - Fax:
Practice Address - Street 1:2901 W COAST HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4023
Practice Address - Country:US
Practice Address - Phone:888-316-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4262364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health