Provider Demographics
NPI:1548480742
Name:BUENO, RACQUEL SMITH (MD)
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:SMITH
Last Name:BUENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 N TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2831
Mailing Address - Country:US
Mailing Address - Phone:808-561-3527
Mailing Address - Fax:
Practice Address - Street 1:34503 9TH AVE S STE 220
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8726
Practice Address - Country:US
Practice Address - Phone:253-944-2080
Practice Address - Fax:253-944-2099
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12516208600000X
WAMD61356110208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2251604Medicaid