Provider Demographics
NPI:1700231388
Name:BAMBALAN, MALU VICTORIA P (FNP)
Entity Type:Individual
Prefix:
First Name:MALU VICTORIA
Middle Name:P
Last Name:BAMBALAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2510 W DUNLAP AVE
Mailing Address - Street 2:STE 290
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2759
Mailing Address - Country:US
Mailing Address - Phone:602-789-0344
Mailing Address - Fax:602-789-8389
Practice Address - Street 1:3945 E PARADISE FALLS DR STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6687
Practice Address - Country:US
Practice Address - Phone:520-290-5888
Practice Address - Fax:520-290-5551
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily