Healthcare Provider Details

I. General information

NPI: 1275996761
Provider Name (Legal Business Name): CLAUDETTE BANARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E. DEL MAR BLVD. #112
PASADENA CA
91105
US

IV. Provider business mailing address

812 1/2 S GLENOAKS BLVD
BURBANK CA
91502-1525
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-2700
  • Fax: 626-564-2770
Mailing address:
  • Phone: 818-206-8267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10486
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number10486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: