Provider Demographics
NPI:1932799848
Name:BALANGUE, WINSTON CARREON I
Entity Type:Individual
Prefix:MR
First Name:WINSTON
Middle Name:CARREON
Last Name:BALANGUE
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:WINSTON
Other - Middle Name:CARREON
Other - Last Name:BALANGUE
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:17425 161ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9142
Mailing Address - Country:US
Mailing Address - Phone:206-473-0854
Mailing Address - Fax:
Practice Address - Street 1:3209 S 23RD ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1602
Practice Address - Country:US
Practice Address - Phone:253-501-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist