=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346162922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BALVINA EVELYN LOERA LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2026
-----------------------------------------------------
Last Update Date | 07/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3724 N 3RD ST FL 2
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85012-2034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-626-8112
-----------------------------------------------------
Fax | 602-875-0242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3030 N CENTRAL AVE STE 506
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85012-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-626-8112
-----------------------------------------------------
Fax | 480-409-3479
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LAC-24157
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------