MEDICARE: CYNTHIA BANUELOS

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	171W00000X	Contractor
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1316747264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA BANUELOS

Provider Business Mailing Address
First Line	:	7351 PICARDIE LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7351 PICARDIE LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1251
Country	:	US
Telephone Number	:	702-741-2306
Fax Number	:

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

Provider Enumeration Date	:	03/18/2025
Last Update Date	:	03/18/2025

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Directions to “ CYNTHIA BANUELOS ” Practice Location

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