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Individual
MANUEL BANUELOS TORRES
Active
Individual
MANUEL BANUELOS TORRES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
01078069A
IN
2086S0120X
Pediatric Surgery Physician
A109447
CA
2086S0120X
Pediatric Surgery Physician
Primary
MD045875
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300001313
—
IN
01
—
P01824825
MEDICARE RR
IN
Enumeration date
02/22/2007
Last updated
01/12/2023
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