Provider Demographics
NPI:1215116678
Name:BALOGUN, EUNICE O (CCP)
Entity type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:O
Last Name:BALOGUN
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DESCANSO DR
Mailing Address - Street 2:APT # 189
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1890
Mailing Address - Country:US
Mailing Address - Phone:408-623-2950
Mailing Address - Fax:650-615-9995
Practice Address - Street 1:130 DESCANSO DR
Practice Address - Street 2:APT # 189
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-1890
Practice Address - Country:US
Practice Address - Phone:408-623-2950
Practice Address - Fax:650-615-9995
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA991199242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist