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General NPI Number Information
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NPI Number | 1952879280
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Entity Type | Individual
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Provider Name | ROMULO MANUEL BANAAG JR.
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Gender | Male
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 2011 N COLLINS BLVD STE 607
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City | RICHARDSON
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State | TX
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Zip | 75080-2636
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Country | US
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Telephone | 800-640-3451
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 NORWAY PINE ST
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City | ARLINGTON
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State | TX
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Zip | 76012-2532
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Country | US
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Telephone | 551-998-1074
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Fax |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP139528
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP139528
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License Number State | TX
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