Provider Demographics
NPI:1700522703
Name:BALBUENA HURTADO, VERONICA ALTAGRACIA
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ALTAGRACIA
Last Name:BALBUENA HURTADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DIVISION STREET
Mailing Address - Street 2:GRIFFIN HOSPITAL
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418
Mailing Address - Country:US
Mailing Address - Phone:203-732-7327
Mailing Address - Fax:
Practice Address - Street 1:130 DIVISION STREET
Practice Address - Street 2:GRIFFIN HOSPITAL
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418
Practice Address - Country:US
Practice Address - Phone:203-732-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-12-29
Deactivation Date:2022-12-27
Deactivation Code:
Reactivation Date:2022-12-29
Provider Licenses
StateLicense IDTaxonomies
390200000X
CTCSP.0079993390200000X
CT1.070817-RES390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program