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General NPI Number Information
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NPI Number | 1295709442
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Entity Type | Individual
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Provider Name | ISABEL BANUCHI M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 302 AVE DOMENECH
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City | SAN JUAN
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State | PR
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Zip | 00918-3509
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Country | US
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Telephone | 787-759-7490
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Fax | 787-759-7150
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Provider Business Mailing Address
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Address Line | 551 CALLE TRIGO
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City | SAN JUAN
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State | PR
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Zip | 00907-2511
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Country | US
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Telephone | 787-759-7490
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Fax | 787-759-7150
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 6037
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License Number State | PR
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