Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | G45949 | CA |
Y | 207R00000X | Internist | G45949 | CA |
Y | 111NI0900X | Internist | G45949 | CA |
NPI | 1295720613 |
---|---|
Provider Name | Dr. Alfonso F Banuelos |
First Address | San Jose, CA 95128-2604 |
Second Address | San Jose, CA 95128-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 13/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G459490 | (05) | CA |
A50241 | (02) | CA |