Provider Demographics
NPI:1922079375
Name:BUENVIAJE-SMITH, SARAH LIGON (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LIGON
Last Name:BUENVIAJE-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16085 TUSCOLA RD
Mailing Address - Street 2:SUITE 2 AND 3
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1358
Mailing Address - Country:US
Mailing Address - Phone:760-810-0301
Mailing Address - Fax:760-927-3256
Practice Address - Street 1:16085 TUSCOLA RD
Practice Address - Street 2:SUITE 2 AND 3
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1358
Practice Address - Country:US
Practice Address - Phone:760-810-0301
Practice Address - Fax:760-927-8885
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11504207L00000X
CAC52647207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506895Medicaid
H39299Medicare UPIN
CACD706YMedicare PIN
NV101167Medicare ID - Type Unspecified