Act Psychiatric Genetics Center P.a.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

L0757 Issued in TX

Legal business name

ACT PSYCHIATRIC GENETICS CENTER P.A.

Practice address

84 NE Loop 410
Ste 140
San Antonio, TX 78216-5860

Phone

(210) 344-0506

Fax

(210) 344-3512

NPI assigned

Dec 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Teresita G Balderas, MD

Title

Owner

Phone

(210) 344-0506

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252368000000",
    "number": "1306020318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 NE LOOP 410",
            "address_2": "STE 140",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782165860",
            "telephone_number": "210-344-0506",
            "fax_number": "210-344-3512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 NE LOOP 410",
            "address_2": "STE 140",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782165860",
            "telephone_number": "210-344-0506",
            "fax_number": "210-344-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACT PSYCHIATRIC GENETICS CENTER P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2009-09-08",
        "status": "A",
        "authorized_official_last_name": "BALDERAS",
        "authorized_official_first_name": "TERESITA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-344-0506",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "L0757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151316001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.