Healthcare Provider Details

I. General information

NPI: 1003708397
Provider Name (Legal Business Name): BALEA AVILA RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 01/11/2026
Certification Date: 01/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N IRWIN ST
HANFORD CA
93230-3848
US

IV. Provider business mailing address

800 N IRWIN ST
HANFORD CA
93230-3848
US

V. Phone/Fax

Practice location:
  • Phone: 559-212-6758
  • Fax:
Mailing address:
  • Phone: 559-212-6758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125K00000X
TaxonomyAdvanced Practice Dental Therapist
License Number1162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: