Healthcare Provider Details

I. General information

NPI: 1972827848
Provider Name (Legal Business Name): JEFFREY BALFUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17539 EATON LN
MONTE SERENO CA
95030-2204
US

IV. Provider business mailing address

17539 EATON LN
MONTE SERENO CA
95030-2204
US

V. Phone/Fax

Practice location:
  • Phone: 408-406-2374
  • Fax:
Mailing address:
  • Phone: 408-406-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG21621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: