Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A173115 | CA |
NPI | 1235405952 |
---|---|
Provider Name | Dr. Jeffrey Daniel Balduzzi |
First Address | Stockton, CA 95207-6204 |
Second Address | Stockton, CA 95207-6204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2012 |
Last Update Date | 04/02/2022 |