Provider Demographics
NPI:1700102787
Name:BALAZS, ANDY
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:BALAZS
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 1:4565 CALLE MAYOR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4458
Mailing Address - Country:US
Mailing Address - Phone:949-933-2014
Mailing Address - Fax:
Practice Address - Street 1:1826 S ELENA AVE STE D
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5718
Practice Address - Country:US
Practice Address - Phone:424-417-9865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health