Healthcare Provider Details

I. General information

NPI: 1144052671
Provider Name (Legal Business Name): SAMUEL BALUIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 555191
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

2224 HUNTINGTON POINT RD UNIT 45
CHULA VISTA CA
91914-3586
US

V. Phone/Fax

Practice location:
  • Phone: 760-622-2852
  • Fax:
Mailing address:
  • Phone: 760-622-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: