Provider Demographics
NPI:1336226067
Name:BALUYUT, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BALUYUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 FULLERTON AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:97881
Mailing Address - Country:US
Mailing Address - Phone:951-371-8805
Mailing Address - Fax:951-371-8813
Practice Address - Street 1:1810 FULLERTON AVE
Practice Address - Street 2:STE 105
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:97881
Practice Address - Country:US
Practice Address - Phone:951-371-8805
Practice Address - Fax:951-371-8813
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA524710Medicaid
CAOOA524710Medicare ID - Type Unspecified
F81154Medicare UPIN