Provider Information for 1073160214
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JEREMIAH C BUENROSTRO
Sex: Male
NPI: 1073160214
Last Updated: 2024-05-08
Certification Date: 2024-03-14
Certification Date: 2024-03-14
Details
| Name | Value | ||||||||||||||
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| NPI | 1073160214 | ||||||||||||||
| Enumeration Date | 2019-08-22 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 18646 OXNARD ST TARZANA, CA 91356-1411 United States Phone: 818-996-1051 | Fax: | ||||||||||||||
| Primary Practice Address | 393 E WALNUT ST PASADENA, CA 91188-1486 United States Phone: 877-457-4772 | Fax: | ||||||||||||||
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