Provider Demographics
NPI:1093281156
Name:BALOY, CZARINA AL (DDS, MHPE)
Entity Type:Individual
Prefix:DR
First Name:CZARINA
Middle Name:AL
Last Name:BALOY
Suffix:
Gender:F
Credentials:DDS, MHPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20191 CAPE CORAL LN APT 301
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-8516
Mailing Address - Country:US
Mailing Address - Phone:714-914-0689
Mailing Address - Fax:
Practice Address - Street 1:1039 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044
Practice Address - Country:US
Practice Address - Phone:323-776-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014163121223G0001X
CA1034711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice