Provider Demographics
NPI:1891227773
Name:DAJER BUENO, JESUS
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:DAJER BUENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 N AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2117
Mailing Address - Country:US
Mailing Address - Phone:786-609-2797
Mailing Address - Fax:
Practice Address - Street 1:6851 N AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2117
Practice Address - Country:US
Practice Address - Phone:786-701-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician