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General NPI Number Information
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NPI Number | 1043435332
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Entity Type | Individual
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Provider Name | JERRY G BALABAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3000 WOODS CIR
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City | DAVIS
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State | CA
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Zip | 95616-2678
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Country | US
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Telephone | 539-219-4528
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 WOODS CIR
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City | DAVIS
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State | CA
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Zip | 95616-2678
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Country | US
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Telephone | 539-219-4528
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY18667
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License Number State | CA
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