MEDICARE: JESSICA BALANGITAO

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1417750043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BALANGITAO

Provider Business Mailing Address
First Line	:	971 SANDY BAY DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32506-8460
Country	:	US
Telephone Number	:	530-632-5627
Fax Number	:

Provider Business Practice Location Address
First Line	:	4047 OKEECHOBEE BLVD STE 124
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3236
Country	:	US
Telephone Number	:	628-833-8424
Fax Number	:

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

Provider Enumeration Date	:	03/29/2025
Last Update Date	:	03/29/2025

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Directions to “ JESSICA BALANGITAO ” Practice Location

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