Provider Demographics
NPI:1265698138
Name:BANUCHI, IVONNE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:MARIE
Last Name:BANUCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 CALLE REINA ANA
Mailing Address - Street 2:LA VILLA DE TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3287
Mailing Address - Country:US
Mailing Address - Phone:787-790-5655
Mailing Address - Fax:
Practice Address - Street 1:281 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3520
Practice Address - Country:US
Practice Address - Phone:787-754-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9529208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation