Provider Demographics
NPI:1144488040
Name:BALMASEDA, ISABEL M (LIC AC, ABT)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:M
Last Name:BALMASEDA
Suffix:
Gender:F
Credentials:LIC AC, ABT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MATHER ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2324
Mailing Address - Country:US
Mailing Address - Phone:617-288-9862
Mailing Address - Fax:
Practice Address - Street 1:3 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021
Practice Address - Country:US
Practice Address - Phone:781-830-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA551171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist