Provider Demographics
NPI:1366239634
Name:BUENO, JAYROLD KEENE
Entity type:Individual
Prefix:
First Name:JAYROLD KEENE
Middle Name:
Last Name:BUENO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 SAN LUIS AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-6699
Mailing Address - Country:US
Mailing Address - Phone:831-247-5429
Mailing Address - Fax:
Practice Address - Street 1:686 LIGHTHOUSE AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1008
Practice Address - Country:US
Practice Address - Phone:831-655-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist