MEDICARE: MISS JOVANA BALKIS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA22508	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235116039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JOVANA BALKIS PA-C

Provider Business Mailing Address
First Line	:	13603 MARINA POINTE DR
Second Line	:	APT B608
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5583
Country	:	US
Telephone Number	:	424-302-7640
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5203
Country	:	US
Telephone Number	:	310-215-6020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	12/08/2014

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