Provider Demographics
NPI:1083035745
Name:BALIDO, JEANNIE YEE
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:YEE
Last Name:BALIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JEANNIE
Other - Middle Name:SUE
Other - Last Name:YEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 GROVE ST STE 204E
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4505
Mailing Address - Country:US
Mailing Address - Phone:415-554-2784
Mailing Address - Fax:415-554-2864
Practice Address - Street 1:101 GROVE ST STE 204E
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4505
Practice Address - Country:US
Practice Address - Phone:415-554-2784
Practice Address - Fax:415-554-2864
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA174400000XOtherSPECIALIST