Provider Demographics
NPI:1891836615
Name:BUENA VIDA MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:BUENA VIDA MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:805-247-0708
Mailing Address - Street 1:311 N ROBERTSON BLVD # 692
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1705
Mailing Address - Country:US
Mailing Address - Phone:805-247-0708
Mailing Address - Fax:805-247-0508
Practice Address - Street 1:215 W PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-7626
Practice Address - Country:US
Practice Address - Phone:805-247-0708
Practice Address - Fax:805-247-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37804261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU94417Medicare UPIN