MEDICARE: VIJETHAA BALAJI

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	310400000X	Assisted Living Facility	331881570	CA

General Provider Information

NPI Number	:	1669339008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJETHAA BALAJI

Provider Business Mailing Address
First Line	:	9509 ESTRELLA HILLS ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-6807
Country	:	US
Telephone Number	:	951-653-1696
Fax Number	:

Provider Business Practice Location Address
First Line	:	9509 ESTRELLA HILLS ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-6807
Country	:	US
Telephone Number	:	951-653-1696
Fax Number	:

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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Directions to “ VIJETHAA BALAJI ” Practice Location

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