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General NPI Number Information
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NPI Number | 1235116039
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Entity Type | Individual
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Provider Name | JOVANA BALKIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 9601 S SEPULVEDA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90045-5203
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Country | US
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Telephone | 310-215-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 13603 MARINA POINTE DR APT B608
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5583
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Country | US
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Telephone | 424-302-7640
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA22508
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License Number State | CA
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