Healthcare Provider Details

I. General information

NPI: 1952328643
Provider Name (Legal Business Name): MRS. JILL M BALOW-DESOUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8606 SE AURORA WAY
HOBE SOUND FL
33455-6704
US

IV. Provider business mailing address

8606 SE AURORA WAY
HOBE SOUND FL
33455-6704
US

V. Phone/Fax

Practice location:
  • Phone: 561-222-9347
  • Fax: 772-546-7186
Mailing address:
  • Phone: 561-222-9347
  • Fax: 772-546-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: