Healthcare Provider Details

I. General information

NPI: 1356287056
Provider Name (Legal Business Name): MATTHEW BALCITA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9285 ELK GROVE BLVD
ELK GROVE CA
95624-2101
US

IV. Provider business mailing address

9105 BRUCEVILLE RD STE 1A
ELK GROVE CA
95758-5970
US

V. Phone/Fax

Practice location:
  • Phone: 916-714-5372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: