Provider Demographics
NPI:1942780572
Name:BALOALOA, ELLIE
Entity Type:Individual
Prefix:MS
First Name:ELLIE
Middle Name:
Last Name:BALOALOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6128 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3051
Mailing Address - Country:US
Mailing Address - Phone:702-598-2048
Mailing Address - Fax:
Practice Address - Street 1:5092 SOUTHERN HILLS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1330
Practice Address - Country:US
Practice Address - Phone:702-368-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker