Provider Demographics
NPI:1184445405
Name:BALDERAS, DORAELIA QUIROZ (FNP-BC)
Entity type:Individual
Prefix:
First Name:DORAELIA
Middle Name:QUIROZ
Last Name:BALDERAS
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAS ANIMAS
Mailing Address - State:CO
Mailing Address - Zip Code:81054-1654
Mailing Address - Country:US
Mailing Address - Phone:830-719-8219
Mailing Address - Fax:
Practice Address - Street 1:701 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054-1654
Practice Address - Country:US
Practice Address - Phone:830-719-8219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-19
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0185371163W00000X
CO1000688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse