Provider Demographics
NPI:1972068872
Name:FONBUENA, GEENA
Entity Type:Individual
Prefix:
First Name:GEENA
Middle Name:
Last Name:FONBUENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 MAIN ST STE B207
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1826
Mailing Address - Country:US
Mailing Address - Phone:503-498-8249
Mailing Address - Fax:458-234-4466
Practice Address - Street 1:714 MAIN ST STE B207
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1826
Practice Address - Country:US
Practice Address - Phone:503-498-8249
Practice Address - Fax:458-234-4466
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator