Healthcare Provider Details

I. General information

NPI: 1669339008
Provider Name (Legal Business Name): VIJETHAA BALAJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9509 ESTRELLA HILLS ST
RIVERSIDE CA
92508-6807
US

IV. Provider business mailing address

9509 ESTRELLA HILLS ST
RIVERSIDE CA
92508-6807
US

V. Phone/Fax

Practice location:
  • Phone: 951-653-1696
  • Fax:
Mailing address:
  • Phone: 951-653-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number331881570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: