Provider Demographics
NPI:1356115604
Name:BALUYOT, ANGELA DORTHINA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DORTHINA
Last Name:BALUYOT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 E ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2264
Mailing Address - Country:US
Mailing Address - Phone:602-903-8255
Mailing Address - Fax:
Practice Address - Street 1:3333 E CAMELBACK RD STE 260
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2390
Practice Address - Country:US
Practice Address - Phone:602-324-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2023061171363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty