Provider Demographics
NPI:1124586268
Name:BALMES-MAMALATEO, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BALMES-MAMALATEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9175 TITAN HILL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4955
Mailing Address - Country:US
Mailing Address - Phone:702-802-3585
Mailing Address - Fax:702-802-5240
Practice Address - Street 1:9175 TITAN HILL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4955
Practice Address - Country:US
Practice Address - Phone:702-802-3585
Practice Address - Fax:702-802-5240
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty