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General NPI Number Information
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NPI Number | 1770821217
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Entity Type | Individual
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Provider Name | KIRSTEN ANN BALOGH NP
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Gender | Female
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 1983 MARENGO ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-1370
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Country | US
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Telephone | 323-226-2622
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Fax |
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Provider Business Mailing Address
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Address Line | 1655 GREENFIELD AVE APT 20
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City | LOS ANGELES
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State | CA
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Zip | 90025-7543
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Country | US
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Telephone | 310-254-5157
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 21694
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 337209
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License Number State | NY
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