Healthcare Provider Details

I. General information

NPI: 1326722679
Provider Name (Legal Business Name): JAMES PABUA BALBIN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4676 ADMIRALTY WAY STE 301
MARINA DEL REY CA
90292-7771
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 424-314-6080
  • Fax: 424-314-6088
Mailing address:
  • Phone: 424-314-6080
  • Fax: 424-314-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95023128
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP95023128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: