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NPI Code Detail

MEDICARE: DR. ROLAND BALUYOT MAWIS MD

MEDICARE: DR. ROLAND BALUYOT MAWIS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianA90715CA
2208D00000XGeneral Practice Physician36113802IL

General Provider Information

NPI Number : 1821000266
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROLAND BALUYOT MAWIS MD
Provider Business Mailing Address
First Line : 12417 FAIR OAKS BLVD STE 600
Second Line :
City : FAIR OAKS
State : CA
Zip : 95628-2500
Country : US
Telephone Number : 916-863-4005
Fax Number : 916-863-4009
Provider Business Practice Location Address
First Line : 12417 FAIR OAKS BLVD STE 600
Second Line :
City : FAIR OAKS
State : CA
Zip : 95628-2500
Country : US
Telephone Number : 916-863-4005
Fax Number : 916-863-4009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2006
Last Update Date : 01/05/2011

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