Provider Demographics
NPI:1457124141
Name:BALANGAUAN, KATHREENA LIM
Entity Type:Individual
Prefix:
First Name:KATHREENA
Middle Name:LIM
Last Name:BALANGAUAN
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 1:100 WILLOW PLZ STE 309
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6215
Mailing Address - Country:US
Mailing Address - Phone:559-372-0523
Mailing Address - Fax:
Practice Address - Street 1:100 WILLOW PLZ STE 309
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6215
Practice Address - Country:US
Practice Address - Phone:559-372-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027865363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health