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General NPI Number Information
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NPI Number | 1487829008
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Entity Type | Individual
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Provider Name | NATHAN J BALFANZ PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 101 S EL CAMINO REAL STE 201
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-5503
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Country | US
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Telephone | 949-880-7997
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Fax |
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Provider Business Mailing Address
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Address Line | 609 CALLE DE SOTO
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-2252
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Country | US
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Telephone | 424-471-9759
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY26707
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY26707
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License Number State | CA
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