Provider Demographics
NPI:1871013474
Name:BUENROSTRO CONTRERAS, JOSE RAUL (LMFT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAUL
Last Name:BUENROSTRO CONTRERAS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 15TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3683
Mailing Address - Country:US
Mailing Address - Phone:415-686-5687
Mailing Address - Fax:
Practice Address - Street 1:3282 ADELINE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2439
Practice Address - Country:US
Practice Address - Phone:510-981-5280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program