Provider Demographics
NPI:1396148508
Name:BALBARINO, MARY JOY DOMINGUEZ (FNP)
Entity type:Individual
Prefix:
First Name:MARY JOY
Middle Name:DOMINGUEZ
Last Name:BALBARINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY JOY
Other - Middle Name:PADUA
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17560 N 75TH AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5968
Mailing Address - Country:US
Mailing Address - Phone:623-512-4390
Mailing Address - Fax:623-512-4139
Practice Address - Street 1:13555 W MCDOWELL RD STE 302
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2629
Practice Address - Country:US
Practice Address - Phone:623-512-4390
Practice Address - Fax:623-512-4139
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily