Healthcare Provider Details

I. General information

NPI: 1427709740
Provider Name (Legal Business Name): PETER BALVUENA ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N ORANGE GROVE BLVD
PASADENA CA
91103-3333
US

IV. Provider business mailing address

8732 IVY ST
LOS ANGELES CA
90002-1536
US

V. Phone/Fax

Practice location:
  • Phone: 626-246-8900
  • Fax:
Mailing address:
  • Phone: 323-579-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number134305
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number134305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: