Healthcare Provider Details

I. General information

NPI: 1982285052
Provider Name (Legal Business Name): JANINE MARIE BALASBAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 N 13TH AVE
UPLAND CA
91786-4916
US

IV. Provider business mailing address

12664 CHAPMAN AVE UNIT 1110
GARDEN GROVE CA
92840-4028
US

V. Phone/Fax

Practice location:
  • Phone: 909-981-8383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: