Provider Demographics
NPI:1295902864
Name:BANUELOS, RONALD GUILLERMO (LAC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:GUILLERMO
Last Name:BANUELOS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2525 WALLINGWOOD DR
Mailing Address - Street 2:BLDG 7C SUITE 705
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6929
Mailing Address - Country:US
Mailing Address - Phone:512-619-2224
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:BLDG 7C SUITE 705
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6929
Practice Address - Country:US
Practice Address - Phone:512-619-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist