Healthcare Provider Details

I. General information

NPI: 1750205571
Provider Name (Legal Business Name): CYNTHIA BALANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OTTERBEIN AVE
ROWLAND HEIGHTS CA
91748-3949
US

IV. Provider business mailing address

9811 BEVERLY LN
GARDEN GROVE CA
92841-3836
US

V. Phone/Fax

Practice location:
  • Phone: 626-965-3448
  • Fax:
Mailing address:
  • Phone: 949-378-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250254928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: