Provider Demographics
NPI:1972561835
Name:BALACUIT, NORMAN PAMINTUAN (DPM)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:PAMINTUAN
Last Name:BALACUIT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-0851
Mailing Address - Country:US
Mailing Address - Phone:909-717-8327
Mailing Address - Fax:626-357-7708
Practice Address - Street 1:416 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2812
Practice Address - Country:US
Practice Address - Phone:626-357-3296
Practice Address - Fax:626-359-5608
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4209213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU75975Medicare UPIN
CAE4209Medicare ID - Type UnspecifiedMONROVIA OFFICE