Healthcare Provider Details

I. General information

NPI: 1912105636
Provider Name (Legal Business Name): FRANKLIN M BANZALI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29112 BRIDALVEIL LN
MENIFEE CA
92584-7507
US

IV. Provider business mailing address

101 THE CITY DR S
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 951-679-0992
  • Fax:
Mailing address:
  • Phone: 714-456-5501
  • Fax: 714-456-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA89606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: