| Dagoberto Balderas, Do, Pllc | |
|
5424 W Highway 290 Ste 101 Austin TX 78735-8838 | |
| (512) 643-4400 | |
| (737) 484-0348 |
| Full Name | Dagoberto Balderas, Do, Pllc |
|---|---|
| Speciality | General Practice |
| Location | 5424 W Highway 290 Ste 101, Austin, Texas |
| Authorized Official Name and Position | Dagoberto Balderas (OWNER) |
| Authorized Official Contact | 5126434400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dagoberto Balderas, Do, Pllc 5424 W Highway 290 Ste 101 Austin TX 78735-8838 Ph: (512) 643-4400 | Dagoberto Balderas, Do, Pllc 5424 W Highway 290 Ste 101 Austin TX 78735-8838 Ph: (512) 643-4400 |
| NPI Number | 1457974065 |
|---|---|
| Provider Enumeration Date | 05/19/2020 |
| Last Update Date | 07/06/2020 |
| Medicare PECOS PAC ID | 0547683153 |
|---|---|
| Medicare Enrollment ID | O20200714002964 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457974065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Dagoberto Balderas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699835843 PECOS PAC ID: 5799949921 Enrollment ID: I20120619000387 |
| Provider Name | Dorothy May Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043466873 PECOS PAC ID: 6103984448 Enrollment ID: I20160610000260 |
| Provider Name | Yanelle Yliana Olmos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609546928 PECOS PAC ID: 5698166775 Enrollment ID: I20211228001126 |
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