Provider Demographics
NPI:1194820670
Name:DR JOAQUIN BALAGUER GROUP PSC
Entity Type:Organization
Organization Name:DR JOAQUIN BALAGUER GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAQUIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAGUER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:787-787-5690
Mailing Address - Street 1:#100 PASEO SAN PABLO
Mailing Address - Street 2:EDIF DR ARTURO CADILLA OFIC 409
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-787-5690
Mailing Address - Fax:787-798-2325
Practice Address - Street 1:#100 PASEO SAN PABLO
Practice Address - Street 2:EDIF DR ARTURO CADILLA OFIC 409
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-787-5690
Practice Address - Fax:787-798-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR051213E00000X
PR105213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0949790001Medicare NSC