Provider Demographics
NPI:1942414586
Name:BALBES, IDELISSE (MD)
Entity Type:Individual
Prefix:
First Name:IDELISSE
Middle Name:
Last Name:BALBES
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:PO BOX 6653
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6653
Mailing Address - Country:US
Mailing Address - Phone:787-426-2038
Mailing Address - Fax:
Practice Address - Street 1:205 AVE ANTONIO R BARCELO
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4127
Practice Address - Country:US
Practice Address - Phone:787-738-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15645208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice