Provider Demographics
NPI:1235308297
Name:BALT, STEVEN LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEO
Last Name:BALT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:705 4TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3233
Mailing Address - Country:US
Mailing Address - Phone:415-484-2258
Mailing Address - Fax:415-684-7774
Practice Address - Street 1:705 4TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3233
Practice Address - Country:US
Practice Address - Phone:415-484-2258
Practice Address - Fax:415-684-7774
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2012-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA878492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry