| Doctor Name: | DR. GARY G. BALESTIN |
| NPI Number: | 1902878366 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD, ABPN, LMFT |
| License Number: | PSY5030 |
| Business Practice Address: | 1475 Huntington Ave Suite 201 South San Francisco, CA - 940805990 |
| Business Phone Number: | 6505883808 |
| Business Fax Number: | 6508735857 |
| Mailing Address: | 1475 Huntington Ave, Suite 201 SOUTH SAN FRANCISCO |
| State: | CA |
| Postal Code: | 940805990 |
| Phone Number: | 6505883808 |
| Fax Number: | 6508735857 |
| NPI Enumeration Date: | 02/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PSY5030 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |