MEDICARE: CYNTHIA BALTAZAR

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	:	1972178507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA BALTAZAR

Provider Business Mailing Address
First Line	:	4221 WILSHIRE BLVD STE 300A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3537
Country	:	US
Telephone Number	:	888-428-3223
Fax Number	:	323-866-1881

Provider Business Practice Location Address
First Line	:	1000 LAKES DR
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-2900
Country	:	US
Telephone Number	:	888-428-3223
Fax Number	:	323-866-1881

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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Directions to “ CYNTHIA BALTAZAR ” Practice Location

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