MEDICARE: NICHOLAS BIALOBOS

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1366803835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS BIALOBOS

Provider Business Mailing Address
First Line	:	JBSA - RANDOLPH
Second Line	:	221 THIRD STREET W. BLDG 1040
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78150
Country	:	US
Telephone Number	:	210-652-6550
Fax Number	:

Provider Business Practice Location Address
First Line	:	JBSA - RANDOLPH
Second Line	:	221 THIRD STREET W. BLDG 1040
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78150
Country	:	US
Telephone Number	:	210-652-6550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	03/15/2026

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Directions to “ NICHOLAS BIALOBOS ” Practice Location

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