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NPI Code Detail

MEDICARE: NATASHA MAE BANAGA BALTAZAR

MEDICARE: NATASHA MAE BANAGA BALTAZAR
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
1225200000XPhysical Therapy Assistant10798CA

General Provider Information

NPI Number : 1336846344
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATASHA MAE BANAGA BALTAZAR
Provider Business Mailing Address
First Line : 14914 1/2 BASSETT ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91405-3577
Country : US
Telephone Number : 714-369-9946
Fax Number :
Provider Business Practice Location Address
First Line : 13400 SHERMAN WAY
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-4415
Country : US
Telephone Number : 818-983-0103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2023
Last Update Date : 02/09/2023

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Directions to “ NATASHA MAE BANAGA BALTAZAR ” Practice Location

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