Healthcare Provider Details

I. General information

NPI: 1750575080
Provider Name (Legal Business Name): MRS. ADRIANA BALANDRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 BANKER RD
CANUTILLO TX
79835-8954
US

IV. Provider business mailing address

1413 BANKER RD
CANUTILLO TX
79835-8954
US

V. Phone/Fax

Practice location:
  • Phone: 915-626-9800
  • Fax:
Mailing address:
  • Phone: 915-626-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: