Provider Demographics
NPI:1770341679
Name:BALMACEDA, SOPHIA GABRIELLE CRISOSTOMO
Entity type:Individual
Prefix:
First Name:SOPHIA GABRIELLE
Middle Name:CRISOSTOMO
Last Name:BALMACEDA
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 1:34069 GANNON TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-1941
Mailing Address - Country:US
Mailing Address - Phone:510-688-8155
Mailing Address - Fax:
Practice Address - Street 1:34069 GANNON TER
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-1941
Practice Address - Country:US
Practice Address - Phone:510-688-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer