Individual
JACLYN BALOGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1095 NW 14TH TER, MIAMI, FL 33136-1060
(305) 243-6946
(305) 243-3337
Mailing address
1095 NW 14TH TER, MIAMI, FL 33136-1060
(305) 243-6946
(305) 243-3337
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9107884
FL
363AS0400X
Surgical Physician Assistant
014089
NY
363AS0400X
Surgical Physician Assistant
MA053542
PA
Other
Enumeration date
09/24/2008
Last updated
12/04/2020
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