Provider Demographics
NPI:1396626578
Name:BUENO FERNANDEZ, EGAR I
Entity type:Individual
Prefix:
First Name:EGAR
Middle Name:
Last Name:BUENO FERNANDEZ
Suffix:I
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 1:2122 DEANNA DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4732
Mailing Address - Country:US
Mailing Address - Phone:210-430-7737
Mailing Address - Fax:
Practice Address - Street 1:2122 DEANNA DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4732
Practice Address - Country:US
Practice Address - Phone:210-430-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-472085106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty