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NPI Code Detail

MEDICARE: CORINA JUAREZ BALTAZAR BT

MEDICARE: CORINA JUAREZ BALTAZAR BT
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1528990579
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORINA JUAREZ BALTAZAR BT
Provider Business Mailing Address
First Line : 809 RONAN AVE
Second Line :
City : WILMINGTON
State : CA
Zip : 90744-4225
Country : US
Telephone Number : 619-376-7479
Fax Number :
Provider Business Practice Location Address
First Line : 25042 NARBONNE AVE
Second Line :
City : LOMITA
State : CA
Zip : 90717-2102
Country : US
Telephone Number : 888-286-8715
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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