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SUSANA BALTAZAR

>> Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities >> Residential Treatment Facilities

Registrant NPI Number: 1851714521

Individual Registrant:
 SUSANA  BALTAZAR 
Gender: F
Sole Proprietor

Location and contact information for practice:
6519 CAL BEARS CT  WINTON, CA 95388-9667 US
Tel: 209-631-3042  Fax: --

Contact information for business:
6519 CAL BEARS CT  WINTON, CA 95388-9667 US
Tel: 209-631-3042  Fax: --

Registration Information:
NPI: 1851714521
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y320600000XResidential Treatment Facilities
Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities
CAVN275554

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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