Provider Demographics
NPI:1366830747
Name:BALDERAS, ALEJANDRO
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:BALDERAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W MILE 3 RD
Mailing Address - Street 2:
Mailing Address - City:PALMHURST
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1633
Mailing Address - Country:US
Mailing Address - Phone:956-585-9889
Mailing Address - Fax:956-585-9896
Practice Address - Street 1:123 W MILE 3 RD
Practice Address - Street 2:
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78573-1633
Practice Address - Country:US
Practice Address - Phone:956-585-9889
Practice Address - Fax:956-585-9896
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212871224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant