Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | M9832 | TX |
NPI | 1003072646 |
---|---|
Provider Name | Dr. Polo Alberto Banuelos |
First Address | San Antonio, TX 78251-4498 |
Second Address | San Antonio, TX 78251-4498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 13/10/2021 |