Provider Demographics
NPI:1063067858
Name:BANEGAS, KEVIN ORLANDO (BA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ORLANDO
Last Name:BANEGAS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-6041
Mailing Address - Country:US
Mailing Address - Phone:504-493-0312
Mailing Address - Fax:
Practice Address - Street 1:1729 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-6041
Practice Address - Country:US
Practice Address - Phone:504-493-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator