Provider Demographics
NPI:1720274277
Name:BANUCHI GARCIA, IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:BANUCHI GARCIA
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:COND MARAMAR BLDG SUITE880
Mailing Address - Street 2:SAN PATRICIO AVENUE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-2645
Mailing Address - Country:US
Mailing Address - Phone:787-707-1977
Mailing Address - Fax:787-707-1975
Practice Address - Street 1:COND MARAMAR BLDG SUITE880
Practice Address - Street 2:SAN PATRICIO AVENUE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-2645
Practice Address - Country:US
Practice Address - Phone:787-707-1977
Practice Address - Fax:787-707-1975
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPR19271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics