MEDICARE: RUBY ANN BANUELOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	MPSS-CIFQUY	CA
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1184847451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBY ANN BANUELOS

Provider Business Mailing Address
First Line	:	3433 W SHAW AVE STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3229
Country	:	US
Telephone Number	:	559-549-6697
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 W SHAW AVE STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3229
Country	:	US
Telephone Number	:	559-549-6697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	01/23/2024

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Directions to “ RUBY ANN BANUELOS ” Practice Location

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