Provider Demographics
NPI:1336991421
Name:ARELLANO HERNANDEZ, BANESA
Entity Type:Individual
Prefix:
First Name:BANESA
Middle Name:
Last Name:ARELLANO HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 GRANT AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2072
Mailing Address - Country:US
Mailing Address - Phone:984-363-0082
Mailing Address - Fax:
Practice Address - Street 1:2320 GRANT AVE APT 206
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2072
Practice Address - Country:US
Practice Address - Phone:984-363-0082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician