Healthcare Provider Details

I. General information

NPI: 1649527219
Provider Name (Legal Business Name): MARIA S. BALDERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11717 BAUMAN RD STE A
HOUSTON TX
77076-1238
US

IV. Provider business mailing address

642 GRENFELL LN
HOUSTON TX
77076-1841
US

V. Phone/Fax

Practice location:
  • Phone: 832-573-9846
  • Fax:
Mailing address:
  • Phone: 832-573-9846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: