Provider Demographics
NPI:1306989975
Name:BALDERAS, TERESITA G (MD)
Entity type:Individual
Prefix:MS
First Name:TERESITA
Middle Name:G
Last Name:BALDERAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:TERESITA
Other - Middle Name:
Other - Last Name:GUZMAN-VILLARREAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:84 NE LOOP 410
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5802
Mailing Address - Country:US
Mailing Address - Phone:210-344-0506
Mailing Address - Fax:210-344-3512
Practice Address - Street 1:84 NE LOOP 410
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5802
Practice Address - Country:US
Practice Address - Phone:210-344-0506
Practice Address - Fax:210-344-3512
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL07572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151316001Medicaid