Healthcare Provider Details

I. General information

NPI: 1437095460
Provider Name (Legal Business Name): KATHERINE JON BALTZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 4TH AVE
CHULA VISTA CA
91911-2012
US

IV. Provider business mailing address

318 FOURTH AVE
CHULA VISTA CA
91910-3802
US

V. Phone/Fax

Practice location:
  • Phone: 619-420-3620
  • Fax:
Mailing address:
  • Phone: 619-420-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC20426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: