Provider Demographics
NPI:1922804723
Name:BALO, PATRICIO LUIS
Entity type:Individual
Prefix:
First Name:PATRICIO
Middle Name:LUIS
Last Name:BALO
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 1:32 CLUBHOUSE LN APT A
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-8266
Mailing Address - Country:US
Mailing Address - Phone:207-714-0387
Mailing Address - Fax:
Practice Address - Street 1:32 CLUBHOUSE LN APT A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-8266
Practice Address - Country:US
Practice Address - Phone:207-714-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities