Provider Demographics
NPI:1578857603
Name:BANAS, IRINEO OCSIO JR (SA-C)
Entity Type:Individual
Prefix:
First Name:IRINEO
Middle Name:OCSIO
Last Name:BANAS
Suffix:JR
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 BOARDWALK BLVD APT F
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3775
Mailing Address - Country:US
Mailing Address - Phone:773-946-0552
Mailing Address - Fax:
Practice Address - Street 1:2547 BOARDWALK BLVD
Practice Address - Street 2:APT. F
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-4716
Practice Address - Country:US
Practice Address - Phone:773-946-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000279246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant