Individual
LESLIE CASTILLO BALUYOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1540 FLORIDA AVE, #100, MODESTO, CA 95350-4430
(209) 577-5557
(209) 577-8125
Mailing address
1540 FLORIDA AVE, #100, MODESTO, CA 95350-4430
(209) 577-5557
(209) 577-8125
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G77685
CA
207UN0901X
Nuclear Cardiology Physician
G77685
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ76734Z
—
CA
Enumeration date
05/30/2006
Last updated
12/13/2021
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