Healthcare Provider Details

I. General information

NPI: 1700837002
Provider Name (Legal Business Name): ROXANA BALUNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

510 E STONER AVE STE 114A
SHREVEPORT LA
71101-4295
US

V. Phone/Fax

Practice location:
  • Phone: 318-990-4773
  • Fax:
Mailing address:
  • Phone: 318-990-4773
  • Fax: 318-990-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD.201950
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01062079
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: