Individual
MIRANDA BALCAZAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4051 BROAD ST STE 110, SAN LUIS OBISPO, CA 93401-8722
(805) 242-1617
Mailing address
159 AVIS ST, ARROYO GRANDE, CA 93420-9705
(951) 809-1314
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Enumeration date
03/04/2024
Last updated
03/04/2024
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