Healthcare Provider Details

I. General information

NPI: 1609792035
Provider Name (Legal Business Name): LAURA BANUELOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16911 BELLFLOWER BLVD
BELLFLOWER CA
90706-5903
US

IV. Provider business mailing address

16911 BELLFLOWER BLVD
BELLFLOWER CA
90706-5903
US

V. Phone/Fax

Practice location:
  • Phone: 714-865-9046
  • Fax:
Mailing address:
  • Phone: 562-866-8956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: