Lafitte Banville, CAODC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

123001 Issued in CA

Practice address

5855 Streamview Dr
San Diego, CA 92105

Phone

(619) 287-5460

NPI assigned

Dec 21, 2017

Last updated

Aug 31, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Twelfth Step House of San Diego, Inc.

  dba Heartland House

  • Substance Abuse Rehabilitation Facility
  • San Diego, CA
  • NPI 1881723344
  NPD (past)

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

{
    "created_epoch": "1513814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535673600000",
    "number": "1750897120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 STREAMVIEW DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921053910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5855 STREAMVIEW DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92105",
            "telephone_number": "619-287-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANVILLE",
        "first_name": "LAFITTE",
        "credential": "CAODC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-21",
        "last_updated": "2018-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "7331",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "123001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAODC",
            "identifier": "7331",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maira Alejandra Banuelos
• Michelle Ishida Banuelos
• Mona C Banuelos, RN
• Nayra Banuelos
• Vanesa Banuelos
• Ayah Fayez Bany-Mohammed
• Charles Ambrose Banzon, MFT
• David Bao, PHARM.D.
• Gang Bao, M.D.
• Loc Bao, D.D.S.

• Addiction (Substance Use Disorder) Counselor in San Diego, CA
• Providers in San Diego, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2018; 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.