Provider Demographics
NPI:1982260873
Name:BALBOA DELGADO, CESAR ALEJANDRO
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:ALEJANDRO
Last Name:BALBOA DELGADO
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 1:2480 W 67TH PL APT 12
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-7818
Mailing Address - Country:US
Mailing Address - Phone:786-427-3999
Mailing Address - Fax:
Practice Address - Street 1:2480 W 67TH PL APT 12
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-7818
Practice Address - Country:US
Practice Address - Phone:786-427-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-79440106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician