MEDICARE: CAMILO A BALFOUR

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1285396523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILO A BALFOUR

Provider Business Mailing Address
First Line	:	7535 N TRELLIS CIR
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3687
Country	:	US
Telephone Number	:	559-679-8126
Fax Number	:

Provider Business Practice Location Address
First Line	:	3863 SHERWOOD PL
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-4607
Country	:	US
Telephone Number	:	720-939-2431
Fax Number	:

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

Provider Enumeration Date	:	10/13/2021
Last Update Date	:	10/13/2021

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Directions to “ CAMILO A BALFOUR ” Practice Location

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