Healthcare Provider Details

I. General information

NPI: 1679400501
Provider Name (Legal Business Name): AGNES DUMAUA BANEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 HONOLULU AVE
MONTROSE CA
91020-1822
US

IV. Provider business mailing address

2340 HONOLULU AVE
MONTROSE CA
91020-1822
US

V. Phone/Fax

Practice location:
  • Phone: 818-952-2294
  • Fax:
Mailing address:
  • Phone: 818-952-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number27720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: