Provider Demographics
NPI:1518581396
Name:BANUELOS, MONA C (RN)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:C
Last Name:BANUELOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6991 BALBOA AVE RM 70
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3447
Mailing Address - Country:US
Mailing Address - Phone:858-496-8232
Mailing Address - Fax:858-496-8234
Practice Address - Street 1:6991 BALBOA AVE RM 70
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3447
Practice Address - Country:US
Practice Address - Phone:858-496-8232
Practice Address - Fax:858-496-8234
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95219920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty