MEDICARE: KAREM BALENTINE

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	103TC1900X	Counseling Psychologist	3703	PR

General Provider Information

NPI Number	:	1750699781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREM BALENTINE

Provider Business Mailing Address
First Line	:	CALLE OLMO #501 HIGHLAND PARK APARTMENTS
Second Line	:	APT # 502
City	:	SAN JUAN
State	:	PR
Zip	:	00924
Country	:	US
Telephone Number	:	787-649-5189
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 AVE PONCE DE LEON
Second Line	:	SUITE 301 COBIANS PLAZA
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1820
Country	:	US
Telephone Number	:	787-649-5189
Fax Number	:

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

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/24/2010

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