Provider Demographics
NPI:1952291551
Name:BALDERAS LLC.
Entity type:Organization
Organization Name:BALDERAS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DORAELIA
Authorized Official - Middle Name:QUIROZ
Authorized Official - Last Name:BALDERAS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:830-719-8219
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-0165
Mailing Address - Country:US
Mailing Address - Phone:830-719-8219
Mailing Address - Fax:
Practice Address - Street 1:701 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054-1654
Practice Address - Country:US
Practice Address - Phone:830-719-8219
Practice Address - Fax:830-719-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty