MEDICARE: ELENA VANESSA BALZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1639738818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA VANESSA BALZA

Provider Business Mailing Address
First Line	:	4422 SW 163RD PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4578
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4422 SW 163RD PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4578
Country	:	US
Telephone Number	:	305-215-6419
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	06/11/2019

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Directions to “ ELENA VANESSA BALZA ” Practice Location

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