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NPI Code Detail

MEDICARE: ELIAS IGNACIO BANUELOS MD

MEDICARE: ELIAS IGNACIO BANUELOS 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
1207Q00000XFamily Medicine PhysicianME97139FL
2207Q00000XFamily Medicine PhysicianA72691CA

Other Identifiers

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

General Provider Information

NPI Number : 1366427064
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIAS IGNACIO BANUELOS MD
Provider Business Mailing Address
First Line : 1141 PEAR TREE LN STE 100
Second Line :
City : NAPA
State : CA
Zip : 94558-6485
Country : US
Telephone Number : 707-254-1770
Fax Number :
Provider Business Practice Location Address
First Line : 911 WASHINGTON ST
Second Line :
City : CALISTOGA
State : CA
Zip : 94515-1433
Country : US
Telephone Number : 707-709-2308
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 09/29/2022

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Directions to “ ELIAS IGNACIO BANUELOS MD” Practice Location

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