Individual
GWENDOLYN BANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
995 GATEWAY CENTER WAY STE 300, SAN DIEGO, CA 92102-4550
(619) 398-2156
(619) 398-2168
Mailing address
11354 VIA RANCHO SAN DIEGO UNIT D, EL CAJON, CA 92019-5203
(619) 309-9598
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN655020
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A2634637
DRIVER LICENSE
CA
Enumeration date
06/07/2018
Last updated
04/05/2019
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