Provider Demographics
NPI:1538756325
Name:BUENAVENTURA, JOHNNA LOUISE (BA)
Entity type:Individual
Prefix:
First Name:JOHNNA
Middle Name:LOUISE
Last Name:BUENAVENTURA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2333
Mailing Address - Country:US
Mailing Address - Phone:216-727-2104
Mailing Address - Fax:216-417-8622
Practice Address - Street 1:2710 WALTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-5037
Practice Address - Country:US
Practice Address - Phone:216-417-8375
Practice Address - Fax:216-417-8622
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator