Individual
FEDERICO BANALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 SANTA MARIA WAY, SANTA MARIA, CA 93455-2118
(805) 934-5400
(805) 938-9207
Mailing address
150 TEJAS PL, NIPOMO, CA 93444-9123
(805) 931-2556
(805) 929-6440
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
A52658
CA
2084P0800X
Psychiatry Physician
Primary
A52658
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275553257
—
CA
05
—
1447277355
—
CA
05
—
1841217866
—
CA
Enumeration date
05/16/2006
Last updated
06/17/2013
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