Provider Demographics
NPI:1831365493
Name:CRISTINA BALSERA M.D. P.A.
Entity type:Organization
Organization Name:CRISTINA BALSERA M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALSERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-571-3777
Mailing Address - Street 1:510 VONDERBURG DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5980
Mailing Address - Country:US
Mailing Address - Phone:813-571-3777
Mailing Address - Fax:813-571-3737
Practice Address - Street 1:510 VONDERBURG DR
Practice Address - Street 2:SUITE 208
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5980
Practice Address - Country:US
Practice Address - Phone:813-571-3777
Practice Address - Fax:813-571-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78809302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259600800Medicaid
FLH23673Medicare UPIN
FL259600800Medicaid