Provider Demographics
NPI:1982241410
Name:VILLASENOR BALCAZAR, ROCIO IVETTE
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:IVETTE
Last Name:VILLASENOR BALCAZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W G ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3657
Mailing Address - Country:US
Mailing Address - Phone:209-710-6132
Mailing Address - Fax:
Practice Address - Street 1:40 W G ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3657
Practice Address - Country:US
Practice Address - Phone:209-710-6132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist