Provider Demographics
NPI:1336301944
Name:BALA-ALBANO, NENITA P (MD)
Entity Type:Individual
Prefix:
First Name:NENITA
Middle Name:P
Last Name:BALA-ALBANO
Suffix:
Gender:F
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:PO BOX 970749
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-0749
Mailing Address - Country:US
Mailing Address - Phone:808-927-1551
Mailing Address - Fax:
Practice Address - Street 1:94-366 PUPUPANI ST STE 118
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2644
Practice Address - Country:US
Practice Address - Phone:808-676-0865
Practice Address - Fax:808-676-1970
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44853207R00000X
HIMD19892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ146732Medicare PIN