Provider Demographics
NPI:1942902937
Name:BALANON, KRISTINE KAREN GAOATEN
Entity Type:Individual
Prefix:
First Name:KRISTINE KAREN
Middle Name:GAOATEN
Last Name:BALANON
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 1:4224 E SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-7120
Mailing Address - Country:US
Mailing Address - Phone:559-229-6024
Mailing Address - Fax:559-229-8093
Practice Address - Street 1:4224 E SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-7120
Practice Address - Country:US
Practice Address - Phone:559-229-6024
Practice Address - Fax:559-229-8093
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician