Provider Demographics
NPI:1902960388
Name:BALETTE, LILY C (MD)
Entity Type:Individual
Prefix:DR
First Name:LILY
Middle Name:C
Last Name:BALETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LILY
Other - Middle Name:C
Other - Last Name:BONET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1141 W. REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247
Mailing Address - Country:US
Mailing Address - Phone:310-327-0245
Mailing Address - Fax:310-327-0116
Practice Address - Street 1:1141 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE #202
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247
Practice Address - Country:US
Practice Address - Phone:310-327-0245
Practice Address - Fax:310-327-0116
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA764702080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine