Provider Demographics
NPI:1518710102
Name:MARTINEZ MERIZALDE BALAREZO, NELSON (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:MARTINEZ MERIZALDE BALAREZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 RAMIREZ PENA AVENUE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:LIMA
Mailing Address - Zip Code:15101
Mailing Address - Country:PE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST. NW
Practice Address - Street 2:DEPT OF INTERNAL MEDICINE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-877-8271
Practice Address - Fax:202-877-6292
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program