Provider Demographics
NPI:1114952264
Name:BALINGIT, PETER PANES (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:PANES
Last Name:BALINGIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14445 OLIVE VIEW DR
Mailing Address - Street 2:2B-182
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1437
Mailing Address - Country:US
Mailing Address - Phone:747-210-3205
Mailing Address - Fax:747-210-4573
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:2B182
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1437
Practice Address - Country:US
Practice Address - Phone:818-364-3205
Practice Address - Fax:818-364-4573
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69847207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A698470Medicaid
CAWA69847CMedicare PIN
CAWA69847BMedicare PIN
CA00A698470Medicaid