Provider Demographics
NPI:1366645137
Name:BALANGUE, ROBERTO DIMAGIBA (RN)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:DIMAGIBA
Last Name:BALANGUE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N VICTORY BLVD
Mailing Address - Street 2:L-138
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1847
Mailing Address - Country:US
Mailing Address - Phone:818-237-7733
Mailing Address - Fax:
Practice Address - Street 1:101 N VICTORY BLVD
Practice Address - Street 2:L-138
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1847
Practice Address - Country:US
Practice Address - Phone:818-237-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429872163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health