| NPI | 1164398889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELMOR BALITAAN Owner 682-651-1396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2025-10-13 |