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NPI Code Detail

MEDICARE: CARLO P BALMASEDA CRNA

MEDICARE: CARLO P BALMASEDA CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse28199938AIN
2367500000XCertified Registered Nurse Anesthetist28199938AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21102564235OTHERINANTHEM

General Provider Information

NPI Number : 1114583564
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLO P BALMASEDA CRNA
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7150 CLEARVISTA DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-1695
Country : US
Telephone Number : 317-621-5890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2019
Last Update Date : 05/05/2026

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Directions to “ CARLO P BALMASEDA CRNA” Practice Location

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