Individual
FABIAN BANUELOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
508 UPLAND ST, KENAI, AK 99611-8026
(907) 335-7500
Mailing address
15138 CAROLS WAY DR, HOUSTON, TX 77070-1117
(915) 502-3362
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
1041C0700X
Clinical Social Worker
Primary
16436
PR
Other
Enumeration date
03/12/2012
Last updated
11/05/2024
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