Healthcare Provider Details

I. General information

NPI: 1942714498
Provider Name (Legal Business Name): LL BANKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SPRINGFIELD DR
CHICO CA
95928-6340
US

IV. Provider business mailing address

PO BOX 12396
BAKERSFIELD CA
93389-2396
US

V. Phone/Fax

Practice location:
  • Phone: 530-342-4885
  • Fax:
Mailing address:
  • Phone: 562-505-5978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE4808
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4808
License Number StateCA

VIII. Authorized Official

Name: LISA BANKS
Title or Position: PODIATRIST
Credential: DPM
Phone: 562-505-5978