Individual
ROBERTA G BANNISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHT
Contact information
Practice address
23394 KNAPPS CUTOFF # 4387, CRESTLINE, CA 92325-9427
(840) 210-1763
Mailing address
PO BOX 4387, CRESTLINE, CA 92325-4387
(840) 210-1763
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
—
CA
101YP1600X
Pastoral Counselor
—
CA
347C00000X
Private Vehicle
—
CA
374K00000X
Religious Nonmedical Practitioner
Primary
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
01/05/2026
Last updated
01/05/2026
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