| NPI | 1689943136 |
|---|---|
| Former Name | JENNIFER BALTAZAR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5363) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA21774) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2025-03-21 |