Provider Demographics
NPI:1235116039
Name:BALKIS, JOVANA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JOVANA
Middle Name:
Last Name:BALKIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13603 MARINA POINTE DR
Mailing Address - Street 2:APT B608
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5583
Mailing Address - Country:US
Mailing Address - Phone:424-302-7640
Mailing Address - Fax:
Practice Address - Street 1:9601 S SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5203
Practice Address - Country:US
Practice Address - Phone:310-215-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22508363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant