Provider Demographics
NPI:1841737103
Name:BALEN, DHEZIREE MAY (PHN)
Entity Type:Individual
Prefix:
First Name:DHEZIREE
Middle Name:MAY
Last Name:BALEN
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3995 ELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-1204
Mailing Address - Country:US
Mailing Address - Phone:925-395-3237
Mailing Address - Fax:
Practice Address - Street 1:3995 ELWOOD CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-1204
Practice Address - Country:US
Practice Address - Phone:925-395-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA764898163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF2101981OtherDRIVER'S LICENSE