Healthcare Provider Details

I. General information

NPI: 1912728361
Provider Name (Legal Business Name): STELLA T BANUELOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N COURT ST
VISALIA CA
93291-4918
US

IV. Provider business mailing address

201 N COURT ST
VISALIA CA
93291-4918
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-2046
  • Fax:
Mailing address:
  • Phone: 559-627-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: