Provider Demographics
NPI:1134420367
Name:BALDERAS, ALICIA IRENE (PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:IRENE
Last Name:BALDERAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-4802
Mailing Address - Country:US
Mailing Address - Phone:806-244-9267
Mailing Address - Fax:
Practice Address - Street 1:1616 S KENTUCKY ST STE B100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2224
Practice Address - Country:US
Practice Address - Phone:806-355-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07004207P00000X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB119321Medicare PIN