Provider Demographics
NPI:1992531313
Name:BALDERAS, MANUEL JACOB (PMHNP)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:JACOB
Last Name:BALDERAS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6016
Mailing Address - Country:US
Mailing Address - Phone:956-310-1180
Mailing Address - Fax:
Practice Address - Street 1:2905 ORIOLE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6016
Practice Address - Country:US
Practice Address - Phone:956-310-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11571742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry