Provider Demographics
NPI:1295709442
Name:BANUCHI, ISABEL (MD)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
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 1:551 CALLE TRIGO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2511
Mailing Address - Country:US
Mailing Address - Phone:787-759-7490
Mailing Address - Fax:787-759-7150
Practice Address - Street 1:302 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3509
Practice Address - Country:US
Practice Address - Phone:787-759-7490
Practice Address - Fax:787-759-7150
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6037207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR97703Medicare ID - Type Unspecified