Healthcare Provider Details

I. General information

NPI: 1184445405
Provider Name (Legal Business Name): DORAELIA QUIROZ BALDERAS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 LOWELL DR
ROCKY FORD CO
81067-2104
US

IV. Provider business mailing address

902 LOWELL DR
ROCKY FORD CO
81067-2104
US

V. Phone/Fax

Practice location:
  • Phone: 830-719-8219
  • Fax: 719-697-1758
Mailing address:
  • Phone: 830-719-8219
  • Fax: 719-697-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1000688
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0185371
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: