Individual
DR. ELLEN MARIE SAN BUENAVENTURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5161 N STONEHOUSE PL, TUCSON, AZ 85750-9671
(520) 749-5889
Mailing address
5161 N STONE HOUSE PL, TUCSON, AZ 85750
(520) 749-5889
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
14454
AZ
208000000X
Pediatrics Physician
14454
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
240119
AHCCCS
AZ
05
—
240119-10
—
AZ
01
—
370016065
RAILROAD MCR
—
Enumeration date
10/19/2006
Last updated
08/07/2012
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