Provider Demographics
NPI:1235681859
Name:BUENO, JOASH (RN)
Entity type:Individual
Prefix:
First Name:JOASH
Middle Name:
Last Name:BUENO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 WOOD DUCK DR
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-2133
Mailing Address - Country:US
Mailing Address - Phone:707-688-8217
Mailing Address - Fax:
Practice Address - Street 1:531 WOOD DUCK DR
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-2133
Practice Address - Country:US
Practice Address - Phone:707-688-8217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95110187163W00000X
CA290720164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No163W00000XNursing Service ProvidersRegistered Nurse