Individual
MRS. JULISSA BALDERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TEACHER
Contact information
Practice address
350 W 110TH ST, NEW YORK, NY 10025-2635
(917) 659-2635
Mailing address
350 WEST 110 STREET, NY, NY 10025
(917) 659-2635
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
534415
NY
Other
Enumeration date
04/27/2013
Last updated
07/22/2013
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