Provider Demographics
NPI:1952328643
Name:BALOW-DESOUZA, JILL M
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:M
Last Name:BALOW-DESOUZA
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 1:8606 SE AURORA WAY
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-6704
Mailing Address - Country:US
Mailing Address - Phone:561-222-9347
Mailing Address - Fax:772-546-7186
Practice Address - Street 1:8606 SE AURORA WAY
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-6704
Practice Address - Country:US
Practice Address - Phone:561-222-9347
Practice Address - Fax:772-546-7186
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist