Provider Demographics
NPI:1225067044
Name:BANDA, CESAR ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:ANTONIO
Last Name:BANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2101
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95609-2101
Mailing Address - Country:US
Mailing Address - Phone:916-289-0415
Mailing Address - Fax:
Practice Address - Street 1:6608 MERCY CT
Practice Address - Street 2:SUITE A
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3170
Practice Address - Country:US
Practice Address - Phone:916-289-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A541300OtherMEDI CAL
CACX635AMedicare PIN
00A541300OtherMEDI CAL