Individual
MONICA BANUELOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 W 21ST ST, CLOVIS, NM 88101-4151
(575) 769-2345
(575) 769-8974
Mailing address
1100 W 21ST ST, CLOVIS, NM 88101-4151
(575) 769-2345
(575) 769-8974
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
T-0161201
NM
Other
Enumeration date
11/01/2013
Last updated
11/01/2013
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