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General NPI Number Information
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NPI Number | 1023520467
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Entity Type | Individual
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Provider Name | MS. PATRICIA N BALTHAZOR
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Gender | Female
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 8265 WHITE OAK AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7671
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Country | US
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Telephone | 909-833-1969
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 CITADEL AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4617
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Country | US
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Telephone | 909-880-8875
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP4640
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License Number State | CA
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