Provider Demographics
NPI:1821000266
Name:MAWIS, ROLAND BALUYOT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:BALUYOT
Last Name:MAWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12417 FAIR OAKS BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2500
Mailing Address - Country:US
Mailing Address - Phone:916-863-4005
Mailing Address - Fax:916-863-4009
Practice Address - Street 1:12417 FAIR OAKS BLVD STE 600
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2500
Practice Address - Country:US
Practice Address - Phone:916-863-4005
Practice Address - Fax:916-863-4009
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90715207Q00000X
IL36113802208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice