Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1831662808 |
---|---|
Provider Name | Patrick D Balbas |
First Address | Waianae, HI 96792-3128 |
Second Address | Waianae, HI 96792-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2019 |
Last Update Date | 02/01/2019 |