Healthcare Provider Details

I. General information

NPI: 1538317771
Provider Name (Legal Business Name): ABRAHAM THOMAS BALSAMO P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 BLUEBERRY HILL RD
EL PRADO NM
87529-7305
US

IV. Provider business mailing address

PO BOX 3141
CARLSBAD NM
88221-3141
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-5858
  • Fax: 575-288-2436
Mailing address:
  • Phone: 575-725-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2008-0042
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: