Provider Demographics
NPI:1366736597
Name:BANALES, MARCOS
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:BANALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-7217
Mailing Address - Country:US
Mailing Address - Phone:415-503-4147
Mailing Address - Fax:415-503-4135
Practice Address - Street 1:2176 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-7217
Practice Address - Country:US
Practice Address - Phone:415-503-4147
Practice Address - Fax:415-503-4135
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor