Healthcare Provider Details

I. General information

NPI: 1871308858
Provider Name (Legal Business Name): EDWIN JONATHAN ASPILI BALURAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 KEMPTON ST
SPRING VALLEY CA
91977-5810
US

IV. Provider business mailing address

2141 SHOREVIEW PL
CHULA VISTA CA
91913-3419
US

V. Phone/Fax

Practice location:
  • Phone: 619-931-1110
  • Fax:
Mailing address:
  • Phone: 619-471-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: