Healthcare Provider Details

I. General information

NPI: 1366907479
Provider Name (Legal Business Name): ALEXANDRA MARIE BALSALOBRE VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 CALLE CESAR GONZALEZ STE 403
SAN JUAN PR
00918-3769
US

IV. Provider business mailing address

576 CALLE CESAR GONZALEZ STE 403
SAN JUAN PR
00918-3769
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-9720
  • Fax:
Mailing address:
  • Phone: 787-754-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number23141
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23141
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23141
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: