Healthcare Provider Details

I. General information

NPI: 1033286372
Provider Name (Legal Business Name): JOSE CARREON BALINAS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY MEDICAL CENTER, BLDG 7 8901 WISCONSIN AVENUE
BETHESDA MD
20889-5600
US

IV. Provider business mailing address

12103 HUNTERS LN
ROCKVILLE MD
20852-2245
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-3440
  • Fax: 301-295-0326
Mailing address:
  • Phone: 301-221-7687
  • Fax: 301-295-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001738
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberC0001738
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: