Provider Demographics
NPI:1366144545
Name:ORTEGA HERNANDEZ, BALIUNIS
Entity type:Individual
Prefix:
First Name:BALIUNIS
Middle Name:
Last Name:ORTEGA HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8066 NW 199TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6392
Mailing Address - Country:US
Mailing Address - Phone:786-246-9363
Mailing Address - Fax:
Practice Address - Street 1:6600 COW PEN RD
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7600
Practice Address - Country:US
Practice Address - Phone:786-246-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner