Provider Demographics
NPI:1881795425
Name:BALITE-LACAP, MONETTE S (MD)
Entity type:Individual
Prefix:
First Name:MONETTE
Middle Name:S
Last Name:BALITE-LACAP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2329
Mailing Address - Country:US
Mailing Address - Phone:702-207-8263
Mailing Address - Fax:
Practice Address - Street 1:1800 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2329
Practice Address - Country:US
Practice Address - Phone:702-207-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14930208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7087383OtherAETNA
CA2552756OtherUNITED
CA095814OtherHEALTH NET
CA8655345OtherCIGNA
CA86734OtherINTERPLAN
CAMCMG409900OtherWESTERN HEALTH ADVANTAGE
CA1559661OtherGREAT WEST
CA2019019OtherFIRST HEALTH
CAA79819OtherBLUE CROSS
CA90129988OtherPACIFICARE
CA095814OtherHEALTH NET
CA7087383OtherAETNA
CA90129988OtherPACIFICARE
CA095814OtherHEALTH NET
CA00A798190Medicare ID - Type Unspecified