Individual
FIDEL DAVID BANUELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
29000 CENTER RIDGE RD STE 150, WESTLAKE, OH 44145-5219
(440) 827-5566
Mailing address
29000 CENTER RIDGE RD STE 150, WESTLAKE, OH 44145-5219
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/19/2022
Last updated
04/19/2022
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