Provider Demographics
NPI:1194314104
Name:BALBAS, SALMA (PA-C)
Entity type:Individual
Prefix:
First Name:SALMA
Middle Name:
Last Name:BALBAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28602 JAEGER DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1320
Mailing Address - Country:US
Mailing Address - Phone:949-525-5087
Mailing Address - Fax:
Practice Address - Street 1:3772 KATELLA AVE STE 206
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6428
Practice Address - Country:US
Practice Address - Phone:562-430-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59047363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant