Individual
MICAH CAMILLE TALUSAN BALUYOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
325 DANFORTH AVE, APT 1B, JERSEY CITY, NJ 07305-1928
(551) 208-3763
Mailing address
325 DANFORTH AVE, APT 1B, JERSEY CITY, NJ 07305-1928
(551) 208-3763
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00229100
NJ
Other
Enumeration date
09/08/2016
Last updated
09/08/2016
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