NPIMap

Individual provider Active NPI

Miriam Bautista Buenaventura, DMD

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1003958745
Registry record updated Dec 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
46030 Issued in CA
Practice address
5031 Eagle Rock Blvd
Los Angeles, CA 90041-1923
Phone
(323) 256-6428
Fax
(323) 256-8439
NPI assigned
Feb 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 46030 CA Primary

Addresses

Primary practice location

5031 Eagle Rock Blvd
Los Angeles, CA 90041-1923

Mailing address

5031 Eagle Rock Blvd
Los Angeles, CA 90041-1923
Phone (323) 256-6428

Other names 1

  • Dr. Miriam Bautista Buenaventura Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Miriam Buenaventura Dental Corporation Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543881600000",
    "number": "1003958745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5031 EAGLE ROCK BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900411923",
            "telephone_number": "323-256-6428",
            "fax_number": "323-256-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5031 EAGLE ROCK BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900411923",
            "telephone_number": "323-256-6428",
            "fax_number": "323-256-8439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUENAVENTURA",
        "first_name": "MIRIAM",
        "middle_name": "BAUTISTA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2018-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "46030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRIAM",
            "last_name": "BUENAVENTURA",
            "middle_name": "BAUTISTA",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.