Healthcare Provider Details

I. General information

NPI: 1144618489
Provider Name (Legal Business Name): ELIZABETH BALIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 CARMICHAEL WAY
CARMICHAEL CA
95608-5314
US

IV. Provider business mailing address

8601 ZIRCON CREST CT
ELK GROVE CA
95624-2851
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-1465
  • Fax:
Mailing address:
  • Phone: 916-821-6986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: