Healthcare Provider Details

I. General information

NPI: 1134039480
Provider Name (Legal Business Name): ANAYANSI BALMACEDA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69730 HIGHWAY 111 STE 100
RANCHO MIRAGE CA
92270-2873
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 760-636-5207
  • Fax: 760-636-5209
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: