Provider Demographics
NPI:1174315493
Name:BANKS, LAILA ALI
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:ALI
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 N CARPENTER RD STE C19
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:209-859-9005
Practice Address - Street 1:1620 N CARPENTER RD STE C19
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1156
Practice Address - Country:US
Practice Address - Phone:209-900-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician