Provider Demographics
NPI:1124749825
Name:BANUELOS, KAREN FERNANDA
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:FERNANDA
Last Name:BANUELOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:FERNANDA
Other - Last Name:URETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4335 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2803
Mailing Address - Country:US
Mailing Address - Phone:562-216-4900
Mailing Address - Fax:
Practice Address - Street 1:6525 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3501
Practice Address - Country:US
Practice Address - Phone:562-801-2268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program