Provider Demographics
NPI:1730681255
Name:BALIZAN, DAPHNNE (RD, LD)
Entity type:Individual
Prefix:
First Name:DAPHNNE
Middle Name:
Last Name:BALIZAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6671 LAS VEGAS BLVD S STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-3273
Mailing Address - Country:US
Mailing Address - Phone:702-761-6911
Mailing Address - Fax:
Practice Address - Street 1:6671 LAS VEGAS BLVD S STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3273
Practice Address - Country:US
Practice Address - Phone:702-761-6911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39354-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered