=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932053121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE ELIZABETH BALISY MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2026
-----------------------------------------------------
Last Update Date | 02/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4540 MICHIGAN AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-269-0681
-----------------------------------------------------
Fax | 323-262-7781
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 S BEAUDRY AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90017-1466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-241-6200
-----------------------------------------------------
Fax | 213-241-8433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 6414
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------