Healthcare Provider Details

I. General information

NPI: 1235048919
Provider Name (Legal Business Name): LARA BALIT FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7037 LAUREL CANYON BLVD STE 104
NORTH HOLLYWOOD CA
91605-5859
US

IV. Provider business mailing address

15104 RUNNYMEDE ST
VAN NUYS CA
91405-1610
US

V. Phone/Fax

Practice location:
  • Phone: 818-579-4012
  • Fax:
Mailing address:
  • Phone: 323-316-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95039308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: