Healthcare Provider Details

I. General information

NPI: 1205115128
Provider Name (Legal Business Name): JAIKRISHNA BALKISSON,MD & LAURIE E. SCHWEITZER, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST 300
BERKELEY CA
94705-2190
US

IV. Provider business mailing address

2999 REGENT STREET 300
BERKELEY CA
94705
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-1717
  • Fax:
Mailing address:
  • Phone: 510-548-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG713950
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG713630
License Number StateCA

VIII. Authorized Official

Name: MISS ANGELIE P. DURANO
Title or Position: MANAGER
Credential: NP
Phone: 510-548-1717