Individual
JON CARLO BANAAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10001 COUNTY FARM RD, RIVERSIDE, CA 92503-3507
(909) 421-7120
Mailing address
18612 SANTA ANA AVE, BLOOMINGTON, CA 92316-2639
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
724480
CA
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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