Provider Demographics
NPI:1255782736
Name:BALLEZA, SHEILA (RN)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:BALLEZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12439 KOKOMO PL
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-6796
Mailing Address - Country:US
Mailing Address - Phone:909-894-6604
Mailing Address - Fax:
Practice Address - Street 1:12439 KOKOMO PLACE
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-6796
Practice Address - Country:US
Practice Address - Phone:909-894-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA756621163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse