Provider Demographics
NPI:1104857366
Name:BALMES, MARICHU MABASA (MD)
Entity Type:Individual
Prefix:
First Name:MARICHU
Middle Name:MABASA
Last Name:BALMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARICHU
Other - Middle Name:MABASA
Other - Last Name:BALMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7400 MERTON MINTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4404
Mailing Address - Country:US
Mailing Address - Phone:210-617-5300
Mailing Address - Fax:
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056314207Q00000X
TXK3981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044679104Medicaid
OK100026430AMedicaid
NM27745Medicaid
G56718Medicare UPIN
TX044679104Medicaid