Healthcare Provider Details

I. General information

NPI: 1306756119
Provider Name (Legal Business Name): SAGE BALASSA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 CAMPTON RD
EUREKA CA
95503-8209
US

IV. Provider business mailing address

1820 WEST AVE
EUREKA CA
95501-3161
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-2660
  • Fax:
Mailing address:
  • Phone: 707-502-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: