1932322823 NPI number — DR. MARLENE BALABANIAN D.C

Table of content: DR. MARLENE BALABANIAN D.C (NPI 1932322823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932322823 NPI number — DR. MARLENE BALABANIAN D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALABANIAN
Provider First Name:
MARLENE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932322823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15550 ROCKFIELD BLVD
Provider Second Line Business Mailing Address:
B220
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-2720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-598-9999
Provider Business Mailing Address Fax Number:
949-598-9990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 GARDENA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204-2726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-663-2926
Provider Business Practice Location Address Fax Number:
323-663-2946
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  167629-95 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC0258410 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BQ041A . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC25841 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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