Healthcare Provider Details

I. General information

NPI: 1114233657
Provider Name (Legal Business Name): MRS. ARELI BALVANEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2010
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S GARFIELD AVE
MONTEBELLO CA
90640-3810
US

IV. Provider business mailing address

10131 SAN GABRIEL AVE APT. B
SOUTH GATE CA
90280-6066
US

V. Phone/Fax

Practice location:
  • Phone: 323-869-9255
  • Fax:
Mailing address:
  • Phone: 714-269-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: