Provider Demographics
NPI:1073657672
Name:BALTA, ABDEL MASSIH (DC)
Entity Type:Individual
Prefix:
First Name:ABDEL
Middle Name:MASSIH
Last Name:BALTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 SLATER AVE
Mailing Address - Street 2:STE 113
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4745
Mailing Address - Country:US
Mailing Address - Phone:714-968-4446
Mailing Address - Fax:714-965-4968
Practice Address - Street 1:10231 SLATER AVE
Practice Address - Street 2:STE 113
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4745
Practice Address - Country:US
Practice Address - Phone:714-968-4446
Practice Address - Fax:714-965-4968
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor