Healthcare Provider Details

I. General information

NPI: 1255283826
Provider Name (Legal Business Name): CASSANDRA DARLENE BALCAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21801 CACTUS AVE STE A
RIVERSIDE CA
92518-3020
US

IV. Provider business mailing address

1443 CAPRI LN
SAN JACINTO CA
92583-5235
US

V. Phone/Fax

Practice location:
  • Phone: 833-526-2333
  • Fax:
Mailing address:
  • Phone: 951-665-9790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: