Individual
GRACE BUENAVENTURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
300 FIR ST, SAN DIEGO, CA 92101-2327
(619) 446-1560
(619) 446-1692
Mailing address
300 FIR ST, SAN DIEGO, CA 92101-2327
(619) 446-1560
(619) 446-1692
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT10478T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0104780
—
CA
Enumeration date
08/05/2006
Last updated
06/14/2013
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