Provider Demographics
NPI:1700522703
Name:BALBUENA HURTADO, VERONICA ALTAGRACIA (MD)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ALTAGRACIA
Last Name:BALBUENA HURTADO
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 1:67 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1328
Mailing Address - Country:US
Mailing Address - Phone:203-732-7327
Mailing Address - Fax:
Practice Address - Street 1:111 WAKELEE AVE
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1151
Practice Address - Country:US
Practice Address - Phone:203-308-2781
Practice Address - Fax:203-308-2726
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2025-01-20
Deactivation Date:2022-12-27
Deactivation Code:
Reactivation Date:2022-12-29
Provider Licenses
StateLicense IDTaxonomies
CTCSP.0079993390200000X
CT1.070817-RES390200000X
CT79984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program