Provider Demographics
NPI:1821284118
Name:BALSEIRO, LAUREANO E (NP)
Entity Type:Individual
Prefix:
First Name:LAUREANO
Middle Name:E
Last Name:BALSEIRO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 FALCON KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:832-866-8145
Mailing Address - Fax:832-965-0442
Practice Address - Street 1:10333 HARWIN DR. SUITE 536
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:713-485-6123
Practice Address - Fax:832-965-0442
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2019-06-29
Deactivation Date:2019-06-05
Deactivation Code:
Reactivation Date:2019-06-27
Provider Licenses
StateLicense IDTaxonomies
104100000X
TXAP138654363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No104100000XBehavioral Health & Social Service ProvidersSocial Worker