Healthcare Provider Details

I. General information

NPI: 1740738384
Provider Name (Legal Business Name): DANIELLA BALABOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 140TH AVE NE APT 36
BELLEVUE WA
98005-1884
US

IV. Provider business mailing address

2440 140TH AVE NE APT 36
BELLEVUE WA
98005-1884
US

V. Phone/Fax

Practice location:
  • Phone: 206-992-9005
  • Fax:
Mailing address:
  • Phone: 206-992-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMC7540
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: