Individual
DANIEL EDMUND BANELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
411 GRANT ST, SALT LAKE CITY, UT 84116-2725
(801) 359-8862
(801) 359-8510
Mailing address
400 NORTH 1756 WEST, APT 56B, SALT LAKE CITY, UT 84116
(801) 359-8862
(801) 359-8510
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376550566
—
UT
Enumeration date
06/15/2012
Last updated
06/15/2012
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