Individual
MRS. DANIELLE BALTAZAR
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
405 CULVER BLVD, #112, PLAYA DEL REY, CA 90293-7767
(310) 403-4015
Mailing address
405 CULVER BLVD, #112, PLAYA DEL REY, CA 90293-7769
(310) 403-4015
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14421
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PW5203
MEDI-CAL
CA
Enumeration date
11/23/2005
Last updated
07/08/2007
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