Provider Demographics
NPI:1184160517
Name:BANKS, JAMINELLI L (DPM)
Entity type:Individual
Prefix:
First Name:JAMINELLI
Middle Name:L
Last Name:BANKS
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20011 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1230
Mailing Address - Country:US
Mailing Address - Phone:480-471-6132
Mailing Address - Fax:480-393-1979
Practice Address - Street 1:7054 E COCHISE RD STE B230
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4550
Practice Address - Country:US
Practice Address - Phone:480-471-6132
Practice Address - Fax:480-393-1979
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-001064213E00000X, 213ES0000X, 213ES0131X, 213ES0103X
CAE5697213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery