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NPI Code Detail

MEDICARE: MISS WANDA BANKS NP

MEDICARE: MISS WANDA BANKS NP
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
1363LF0000XFamily Nurse Practitioner11336CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NP11336OTHERCANP LICENSE NUMBER

General Provider Information

NPI Number : 1881736692
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS WANDA BANKS NP
Provider Business Mailing Address
First Line : 1774 ZONAL AVE BLDG E
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1064
Country : US
Telephone Number : 562-867-7999
Fax Number :
Provider Business Practice Location Address
First Line : 1774 ZONAL AVE BLDG E
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1064
Country : US
Telephone Number : 562-867-7999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 04/29/2026

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