Provider Demographics
NPI:1720166770
Name:BUENAFLOR, JAY KENNETH PALOMA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY KENNETH
Middle Name:PALOMA
Last Name:BUENAFLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 MESQUITE AVE
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-3487
Mailing Address - Country:US
Mailing Address - Phone:760-344-2445
Mailing Address - Fax:
Practice Address - Street 1:608 G ST
Practice Address - Street 2:I-A
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2568
Practice Address - Country:US
Practice Address - Phone:760-351-2127
Practice Address - Fax:760-351-2163
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82945208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A829450Medicaid
CAWA82945AMedicare PIN