Healthcare Provider Details

I. General information

NPI: 1497372676
Provider Name (Legal Business Name): MISS BRITTANY NICOLE BANUELOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 KINGS COUNTY DR STE 106
HANFORD CA
93230-5954
US

IV. Provider business mailing address

400 OYSTER POINT BLVD STE 501
SOUTH SAN FRANCISCO CA
94080-7600
US

V. Phone/Fax

Practice location:
  • Phone: 559-754-3128
  • Fax:
Mailing address:
  • Phone: 650-866-4080
  • Fax: 650-866-4083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: