Provider Demographics
NPI:1619560422
Name:BALILO, RODNEY RICAFORT
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:RICAFORT
Last Name:BALILO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5506
Mailing Address - Country:US
Mailing Address - Phone:707-333-1458
Mailing Address - Fax:
Practice Address - Street 1:702 CAROLINA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5506
Practice Address - Country:US
Practice Address - Phone:707-333-1458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor