Healthcare Provider Details

I. General information

NPI: 1194820670
Provider Name (Legal Business Name): DR JOAQUIN BALAGUER GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#100 PASEO SAN PABLO EDIF DR ARTURO CADILLA OFIC 409
BAYAMON PR
00961
US

IV. Provider business mailing address

#100 PASEO SAN PABLO EDIF DR ARTURO CADILLA OFIC 409
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-5690
  • Fax: 787-798-2325
Mailing address:
  • Phone: 787-787-5690
  • Fax: 787-798-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number051
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number105
License Number StatePR

VIII. Authorized Official

Name: DR. JOAQUIN BALAGUER
Title or Position: PRESIDENT
Credential: DPM
Phone: 787-787-5690