Individual
JOEL BANUELOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
290 DIVISION ST STE 200, SAN FRANCISCO, CA 94103-4892
(415) 271-6545
Mailing address
1826 WILL SCARLET LN, SANTA ROSA, CA 95405-4619
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
69708
CA
Other
Enumeration date
03/02/2021
Last updated
03/02/2021
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