Provider Demographics
NPI:1720134729
Name:BALFOUR, ANTONIA MARIE (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANTONIA
Middle Name:MARIE
Last Name:BALFOUR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16704 BOLLINGER DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3218
Mailing Address - Country:US
Mailing Address - Phone:310-454-5855
Mailing Address - Fax:310-526-7341
Practice Address - Street 1:16704 BOLLINGER DR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3218
Practice Address - Country:US
Practice Address - Phone:310-454-5855
Practice Address - Fax:310-526-7341
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7354171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist