Provider Demographics
NPI:1245419506
Name:BALAT, MAGGIE MAE CABRAL (RN)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE MAE
Middle Name:CABRAL
Last Name:BALAT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2609
Mailing Address - Country:US
Mailing Address - Phone:619-931-8245
Mailing Address - Fax:
Practice Address - Street 1:4420 HOTEL CIRCLE CT STE 130
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3493
Practice Address - Country:US
Practice Address - Phone:619-543-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA709745163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse