Healthcare Provider Details

I. General information

NPI: 1649587726
Provider Name (Legal Business Name): GINA M TORRES BALSAMO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA MARIE TORRES PA-C

II. Dates (important events)

Enumeration Date: 09/09/2010
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:
Mailing address:
  • Phone: 575-725-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2010-0048
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: