Fabian Banuelos

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

16436 Issued in PR

Practice address

508 Upland St
Kenai, AK 99611-8026

Phone

(907) 335-7500

NPI assigned

Mar 12, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1427323328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15138 CAROLS WAY DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770701117",
            "telephone_number": "915-502-3362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 UPLAND ST",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996118026",
            "telephone_number": "907-335-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9837 Naomi Dr",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799272832",
            "country_code": "US",
            "telephone_number": "915-820-1080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANUELOS",
        "first_name": "FABIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-12",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PR",
            "license": "16436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chrystena Lyn Bahr
• Christine Bailey
• Suzan Camille Baker
• David Lee Baldridge, D.C.
• Jamie Lynn Ball, CDCI
• Breanna Barnhart
• Kellie G Bartelmay
• Lisa J Bass
• Mary M Bassir, PSYD
• James Robert Bauman IV, DO

• All providers in Kenai, AK
• Clinical Social Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.