Healthcare Provider Details

I. General information

NPI: 1033443916
Provider Name (Legal Business Name): MYLEEN BASA BALUYOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W CHRISTOFFERSEN PKWY
TURLOCK CA
95382-9547
US

IV. Provider business mailing address

PO BOX 3768
MERCED CA
95344-3768
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-6097
  • Fax:
Mailing address:
  • Phone: 209-723-6351
  • Fax: 209-723-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA109530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: