Individual
JOSE BANUELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC, FNP-C
Contact information
Practice address
69175 RAMON RD BLDG A, CATHEDRAL CITY, CA 92234-3344
(760) 321-6776
Mailing address
69175 RAMON RD BLDG A, CATHEDRAL CITY, CA 92234-3344
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
95013880
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95013880
CA
Other
Enumeration date
07/02/2019
Last updated
11/03/2025
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