Individual
LYDIA BANUELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
947 S. ANAHEIM BLVD., SUITE 120, ANAHEIM, CA 92805-5590
(714) 821-4666
(714) 533-6800
Mailing address
888 S. DISNEYLAND DRIVE, SUITE 100, ANAHEIM, CA 92802-1828
(714) 901-2007
(714) 901-2003
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
33339
AZ
207W00000X
Ophthalmology Physician
Primary
A65937
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
887440
—
AZ
01
—
P00447251
RAILROAD MEDICARE
AZ
Enumeration date
02/06/2006
Last updated
09/06/2012
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