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General NPI Number Information
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NPI Number | 1063554426
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Entity Type | Individual
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Provider Name | JAY A BALESTRIERI NP
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 400 W 17TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-2649
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Country | US
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Telephone | 719-296-6872
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Fax | 719-583-0688
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Provider Business Mailing Address
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Address Line | 1235 N BLAZING TRAIL DR
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City | PUEBLO WEST
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State | CO
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Zip | 81007-3934
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Country | US
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Telephone | 719-251-2071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 109032
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License Number State | CO
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