Healthcare Provider Details

I. General information

NPI: 1265249015
Provider Name (Legal Business Name): VICTORIA BALZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 RESEARCH PARK DR # B-1A
ANN ARBOR MI
48108-2229
US

IV. Provider business mailing address

518 LINDEN ST
ANN ARBOR MI
48104-2617
US

V. Phone/Fax

Practice location:
  • Phone: 734-794-2930
  • Fax:
Mailing address:
  • Phone: 248-929-1457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: