Individual
HEATHER PETRILLO BALOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1715 E WILSHIRE AVE, SANTA ANA, CA 92705-4644
(714) 245-6769
Mailing address
1715 E WILSHIRE AVE STE 706, SANTA ANA, CA 92705-4652
(714) 245-6769
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
4105
CA
Other
Enumeration date
03/22/2021
Last updated
03/22/2021
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