Basic Information
| Provider Information | |||||||||
| NPI: | 1548605587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALUYUT | ||||||||
| FirstName: | VIRGILIO | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1510 4TH ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947101717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105258980 | ||||||||
| FaxNumber: | 5105258982 | ||||||||
| Practice Location | |||||||||
| Address1: | 1510 4TH ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947101717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105258980 | ||||||||
| FaxNumber: | 5105258982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2013 | ||||||||
| LastUpdateDate: | 05/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NPF22735 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.