Karlomikhail Nono Buenaseda I, PT

Individual provider Active NPI Licensed Psychiatric Technician · Pico Rivera, CA

NPI 1104011345 · NPPES record last updated Sep 11, 2007

Key facts

NPI
1104011345
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Psychiatric Technician 167G00000X
License
PT 33472 (CA)
Practice address
9140 Whittier Blvd
Pico Rivera, CA 90660-2444
Phone
(562) 801-4626
Fax
(562) 801-4630
NPI assigned
Sep 11, 2007
Sex
Male
Sole proprietor
Yes

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
PT 33472CAMDLicensed Psychiatric Technician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Psychiatric Technician 167G00000X PT 33472 CA Yes

Addresses

Primary practice location

9140 Whittier Blvd
Pico Rivera, CA 90660-2444

Mailing address

226 E 31St St
Long Beach, CA 90807-5004
Phone (562) 912-7541

Other providers in Pico Rivera, CA

All providers in Pico Rivera, CA · Licensed Psychiatric Technician in California

Sources for this page

Verify at the official NPI Registry.