Provider Demographics
NPI:1053586990
Name:BUENDIA, MAURICIO AUGUSTO (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:AUGUSTO
Last Name:BUENDIA
Suffix:
Gender:M
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:P O BOX 901650
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33090
Mailing Address - Country:US
Mailing Address - Phone:305-674-3888
Mailing Address - Fax:305-674-3388
Practice Address - Street 1:950 N KROME AVE
Practice Address - Street 2:202
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4400
Practice Address - Country:US
Practice Address - Phone:305-674-3888
Practice Address - Fax:305-674-3388
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101095207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL148J2OtherBC/BS
FL001854600Medicaid
FLN240150OtherWELLCARE
FL336803OtherAVMED
FL148J2OtherBC/BS