Provider Demographics
NPI:1972092997
Name:BALUYOT, JAZZMINE-ROSE (DO)
Entity type:Individual
Prefix:
First Name:JAZZMINE-ROSE
Middle Name:
Last Name:BALUYOT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:615-682-0547
Practice Address - Street 1:3830 E FLAMINGO RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6234
Practice Address - Country:US
Practice Address - Phone:725-269-1044
Practice Address - Fax:725-269-1046
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVDO2962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO2962OtherSTATE LICENSE
NV1972092997Medicaid