Provider Demographics
NPI:1770334443
Name:BALBOA, GIOVANNA
Entity type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:
Last Name:BALBOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 FLINT CT
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-6829
Mailing Address - Country:US
Mailing Address - Phone:909-490-1205
Mailing Address - Fax:
Practice Address - Street 1:1377 FLINT CT
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-6829
Practice Address - Country:US
Practice Address - Phone:909-490-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist