Basic Information
| Provider Information | |||||||||
| NPI: | 1538654546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUENO | ||||||||
| FirstName: | YANEL | ||||||||
| MiddleName: | LARYSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 E 4TH ST STE 116 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148248150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 FREMONT AVE # 666 | ||||||||
| Address2: | |||||||||
| City: | SOUTH PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910303224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146738336 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2018 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 108291 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.