Individual
DR. CRAIG S BANTA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 W FERN AVE, REDLANDS, CA 92373-5916
(909) 793-3311
(909) 796-4158
Mailing address
PO BOX 2200, REDLANDS, CA 92373-0722
(909) 793-3311
(909) 796-4158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G38986
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G389860
—
CA
Enumeration date
06/17/2006
Last updated
07/08/2007
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