Provider Demographics
NPI:1487829008
Name:BALFANZ, NATHAN J (PSYD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:J
Last Name:BALFANZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 CALLE DE SOTO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2252
Mailing Address - Country:US
Mailing Address - Phone:424-471-9759
Mailing Address - Fax:
Practice Address - Street 1:101 S EL CAMINO REAL STE 201
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5503
Practice Address - Country:US
Practice Address - Phone:949-880-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26707103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent