Provider Demographics
NPI:1801689898
Name:BUENO CLINIC
Entity type:Organization
Organization Name:BUENO CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:321-285-9907
Mailing Address - Street 1:2921 S ORLANDO DR STE 130
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-4106
Mailing Address - Country:US
Mailing Address - Phone:321-285-9907
Mailing Address - Fax:
Practice Address - Street 1:2921 S ORLANDO DR STE 130
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-4106
Practice Address - Country:US
Practice Address - Phone:321-285-9907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty