Provider Demographics
NPI:1053949347
Name:BALANTAC, ZACHARY ALEXANDER
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:ALEXANDER
Last Name:BALANTAC
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 1:2519 KNIGHTWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-5106
Mailing Address - Country:US
Mailing Address - Phone:916-849-5425
Mailing Address - Fax:
Practice Address - Street 1:9470 MICRON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2612
Practice Address - Country:US
Practice Address - Phone:916-337-9842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician