Provider Demographics
NPI:1538576863
Name:BALDERAS, CORINA
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:BALDERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 N BENTSEN PALM DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-7112
Mailing Address - Country:US
Mailing Address - Phone:956-205-2584
Mailing Address - Fax:956-271-4324
Practice Address - Street 1:1312 OBLATE AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4027
Practice Address - Country:US
Practice Address - Phone:956-205-2584
Practice Address - Fax:956-580-2199
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138248261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care