Provider Demographics
NPI:1285396523
Name:BALFOUR, CAMILO A
Entity type:Individual
Prefix:
First Name:CAMILO
Middle Name:A
Last Name:BALFOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7535 N TRELLIS CIR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3687
Mailing Address - Country:US
Mailing Address - Phone:559-679-8126
Mailing Address - Fax:
Practice Address - Street 1:3863 SHERWOOD PL
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-4607
Practice Address - Country:US
Practice Address - Phone:720-939-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic