Healthcare Provider Details

I. General information

NPI: 1326027806
Provider Name (Legal Business Name): GUITA BALAKHANE M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE# 695W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST STE# 695W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-967-2140
  • Fax:
Mailing address:
  • Phone: 310-967-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG63871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: