MEDICARE: DELRAE Y BALGAS LM

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	176B00000X	Midwife	LM 140	AZ

General Provider Information

NPI Number	:	1902075831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELRAE Y BALGAS LM

Provider Business Mailing Address
First Line	:	PO BOX 5265
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-5265
Country	:	US
Telephone Number	:	714-450-0069
Fax Number	:

Provider Business Practice Location Address
First Line	:	5031 E ORANGETHORPE AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-1131
Country	:	US
Telephone Number	:	714-450-0069
Fax Number	:

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

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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