Provider Demographics
NPI:1669544227
Name:FAMILY HEALTHCARE OF CORONA
Entity type:Organization
Organization Name:FAMILY HEALTHCARE OF CORONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALUYUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-371-8805
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:92881
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:92881
Practice Address - Country:US
Practice Address - Phone:951-371-8805
Practice Address - Fax:951-371-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32490ZMedicare ID - Type Unspecified
F81154Medicare UPIN