Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A84212 | CA |
NPI | 1013091008 |
---|---|
Provider Name | Krisztina J. Balazs |
First Address | Oakland, CA 94612-3466 |
Second Address | Santa Rosa, CA 95403-2149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A842120 | (05) | CA |
G93100 | (02) |