Provider Demographics
NPI:1194949503
Name:BALSALOBRE, DIANA (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BALSALOBRE
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 1:201 N PARK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4147
Mailing Address - Country:US
Mailing Address - Phone:407-889-1199
Mailing Address - Fax:407-889-1193
Practice Address - Street 1:201 N PARK AVE STE 201
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4147
Practice Address - Country:US
Practice Address - Phone:407-889-1199
Practice Address - Fax:407-889-1193
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR137122084N0400X
FLME1294992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology