Individual
LISA M BANUELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 HOSPITAL DR FL 2, VALLEJO, CA 94589-2580
(707) 427-4900
Mailing address
1318 THRASHER WAY, SUISUN CITY, CA 94585-3019
(707) 246-9954
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95290679
CA
Other
Enumeration date
05/27/2025
Last updated
05/27/2025
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