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General NPI Number Information
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NPI Number | 1831904796
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Entity Type | Individual
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Provider Name | IDA BALIGOD CLINIC NURSE
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Gender | Female
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 40910 FREMONT BLVD
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City | FREMONT
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State | CA
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Zip | 94538-4375
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Country | US
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Telephone | 510-770-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 38043 MILLER PL
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City | FREMONT
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State | CA
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Zip | 94536-3825
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Country | US
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Telephone | 408-674-8112
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 345998
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License Number State | CA
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