Provider Demographics
NPI:1033120647
Name:BALZAC, MARIA DE LOS ANGELES (MD)
Entity Type:Individual
Prefix:
First Name:MARIA DE LOS ANGELES
Middle Name:
Last Name:BALZAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HACIENDA REAL #253
Mailing Address - Street 2:LLUVIA DE CORAL ST.
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-769-9903
Mailing Address - Fax:
Practice Address - Street 1:VA CARIBBEAN HEALTH CENTER -PSYCH DEPT.
Practice Address - Street 2:10 CASIA ST.
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-758-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR126262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry