Provider Demographics
NPI:1609427814
Name:BALAHADIA, JOAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:BALAHADIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:SARMIENTO
Other - Last Name:BALAHADIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:13934 MENNONITE PT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3134
Mailing Address - Country:US
Mailing Address - Phone:858-603-3100
Mailing Address - Fax:
Practice Address - Street 1:4276 54TH PL STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6011
Practice Address - Country:US
Practice Address - Phone:619-501-5511
Practice Address - Fax:951-325-5868
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA740273163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty