Provider Demographics
NPI:1033134770
Name:CRESENCIA D BANZUELA M.D. INC
Entity Type:Organization
Organization Name:CRESENCIA D BANZUELA M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRESENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-272-6595
Mailing Address - Street 1:PO BOX 6038
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-6038
Mailing Address - Country:US
Mailing Address - Phone:951-272-3872
Mailing Address - Fax:
Practice Address - Street 1:260 E ONTARIO AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3506
Practice Address - Country:US
Practice Address - Phone:951-272-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty