Provider Demographics
NPI:1508577917
Name:NGONZO, HANAIS BANZA
Entity Type:Individual
Prefix:
First Name:HANAIS
Middle Name:BANZA
Last Name:NGONZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 BUTCHER RD STE A
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5691
Mailing Address - Country:US
Mailing Address - Phone:707-724-6810
Mailing Address - Fax:
Practice Address - Street 1:183 BUTCHER RD STE A
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5691
Practice Address - Country:US
Practice Address - Phone:707-724-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician