Provider Demographics
NPI:1528253309
Name:BALANQUIT, ZALDY L I
Entity type:Individual
Prefix:
First Name:ZALDY
Middle Name:L
Last Name:BALANQUIT
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 RANCHEROS DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2965
Mailing Address - Country:US
Mailing Address - Phone:760-744-0020
Mailing Address - Fax:
Practice Address - Street 1:330 RANCHEROS DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2965
Practice Address - Country:US
Practice Address - Phone:760-744-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor