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General NPI Number Information
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NPI Number | 1356115604
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Entity Type | Individual
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Provider Name | ANGELA DORTHINA BALUYOT PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 3333 E CAMELBACK RD STE 260
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City | PHOENIX
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State | AZ
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Zip | 85018-2390
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Country | US
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Telephone | 602-324-4622
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 E ANDERSON DR
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City | PHOENIX
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State | AZ
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Zip | 85032-2264
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Country | US
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Telephone | 602-903-8255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2023061171
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License Number State | AZ
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