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NPI Code Detail

MEDICARE: FEDERICO BANALES MD

MEDICARE: FEDERICO BANALES MD
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
12084F0202XForensic Psychiatry PhysicianA52658CA
22084P0800XPsychiatry PhysicianA52658CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255383485
Entity Type Code : Individual
Provider Name (Legal Business Name) : FEDERICO BANALES MD
Provider Business Mailing Address
First Line : 150 TEJAS PL
Second Line :
City : NIPOMO
State : CA
Zip : 93444-9123
Country : US
Telephone Number : 805-931-2556
Fax Number : 805-929-6440
Provider Business Practice Location Address
First Line : 2801 SANTA MARIA WAY
Second Line :
City : SANTA MARIA
State : CA
Zip : 93455-2118
Country : US
Telephone Number : 805-934-5400
Fax Number : 805-938-9207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 06/17/2013

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Directions to “ FEDERICO BANALES MD” Practice Location

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