Healthcare Provider Details

I. General information

NPI: 1780459958
Provider Name (Legal Business Name): REEM BALLOUT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 SALK AVE
CARLSBAD CA
92008-7346
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-827-7210
  • Fax:
Mailing address:
  • Phone: 760-827-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: