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Individual
MRS. TERESITA SANTOS BANEZ
Active
Individual
MRS. TERESITA SANTOS BANEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
108352
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000606317B
—
GA
Enumeration date
04/02/2009
Last updated
04/02/2009
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