Individual
IRENE DALUSUNG BALUYUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3569 ROUND BARN CIR, SANTA ROSA, CA 95403-5781
(707) 303-3600
Mailing address
3569 ROUND BARN CIR, SANTA ROSA, CA 95403-5781
(707) 303-3600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A87105
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0-489-641-1
ECFMG#
CA
01
—
A87105
CA MEDICAL LICENSE
CA
Enumeration date
05/07/2007
Last updated
10/04/2016
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