Individual
CHANEL AGNES BANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16500 VENTURA BLVD, SUITE 414, ENCINO, CA 91436-2011
(818) 788-1003
Mailing address
16500 VENTURA BLVD, SUITE 414, ENCINO, CA 91436-2011
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
1603977772
NV
2355S0801X
Speech-Language Assistant
Primary
2923
CA
Other
Enumeration date
03/05/2011
Last updated
04/15/2015
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