Healthcare Provider Details

I. General information

NPI: 1932885993
Provider Name (Legal Business Name): MARYBETH MUEGA BALZA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 BARTLET AVE
HAYWARD CA
94541
US

IV. Provider business mailing address

5501 SIGNAL HILL DR
DUBLIN CA
94568
US

V. Phone/Fax

Practice location:
  • Phone: 510-785-3630
  • Fax:
Mailing address:
  • Phone: 925-548-9728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number49492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: