Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | OS15730 | FL |
NPI | 1295928380 |
---|---|
Provider Name | Aiysha C Balbosa |
First Address | Mirarmar, FL 33025-3925 |
Second Address | Coral Springs, FL 33076-3388 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 17/03/2021 |