Provider Demographics
NPI:1609005321
Name:BALBONA, MITZI DOREEN BALADIANG (MD)
Entity Type:Individual
Prefix:
First Name:MITZI DOREEN
Middle Name:BALADIANG
Last Name:BALBONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MITZI DOREEN
Other - Middle Name:
Other - Last Name:BALADIANG-BALBONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1842 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-4808
Mailing Address - Country:US
Mailing Address - Phone:831-233-2000
Mailing Address - Fax:
Practice Address - Street 1:US HWY 101S
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:CA
Practice Address - Zip Code:93960
Practice Address - Country:US
Practice Address - Phone:831-237-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100206220Medicaid
KYK050350Medicare PIN
KYK050351Medicare PIN
KYK050353Medicare PIN
KYK050352Medicare PIN