MEDICARE: ANDREW BANES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1134085814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW BANES

Provider Business Mailing Address
First Line	:	11799 SEBASTIAN WAY STE 103
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-0708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34480 COUNTY LINE RD SPC 20
Second Line	:
City	:	YUCAIPA
State	:	CA
Zip	:	92399-5316
Country	:	US
Telephone Number	:	909-709-2922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/26/2025

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Directions to “ ANDREW BANES ” Practice Location

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