Provider Demographics
NPI:1861648560
Name:BANKO, LESANEMARIAM TENKIR (MD)
Entity Type:Individual
Prefix:
First Name:LESANEMARIAM
Middle Name:TENKIR
Last Name:BANKO
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 1:12984 HESPERIA RD
Mailing Address - Street 2:STE 100
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5819
Mailing Address - Country:US
Mailing Address - Phone:760-843-7675
Mailing Address - Fax:760-843-7649
Practice Address - Street 1:12984 HESPERIA RD
Practice Address - Street 2:STE 100
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5819
Practice Address - Country:US
Practice Address - Phone:760-843-7675
Practice Address - Fax:760-843-7649
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104321207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease