MEDICARE: AMANDA BOUY BALCH WHNP

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	363L00000X	Nurse Practitioner	NP20385	CA

General Provider Information

NPI Number	:	1760775639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BOUY BALCH WHNP

Provider Business Mailing Address
First Line	:	10170 SORRENTO VALLEY RD
Second Line	:	MAIL DROP SV-5
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1604
Country	:	US
Telephone Number	:	858-784-5888
Fax Number	:

Provider Business Practice Location Address
First Line	:	951 MARINERS ISLAND BLVD
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94404-1558
Country	:	US
Telephone Number	:	650-285-6927
Fax Number	:	888-352-7383

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

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	02/25/2022

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