Provider Demographics
NPI:1447780614
Name:HOLGUIN BALBUENA, SILERA MERCEDES (MD)
Entity Type:Individual
Prefix:
First Name:SILERA
Middle Name:MERCEDES
Last Name:HOLGUIN BALBUENA
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 1:1220 E CUMBERLAND AVE UNIT 123
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4253
Mailing Address - Country:US
Mailing Address - Phone:019-534-0262
Mailing Address - Fax:
Practice Address - Street 1:3100 MACCORKLE AVE STE 205
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-388-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31018207RR0500X
00000000000000000000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program