Active NPI
Raquel Balderas, MD
- Psychiatry Physician
- Prescott Valley, AZ
National Provider Identifier
1639169154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 32337
- Practice address
- 3345 N Windsong Dr
Windsong Center
Prescott Valley, AZ 86314-2283 - Phone
- (928) 445-5211
- Fax
- (928) 776-8484
- NPI assigned
- Oct 26, 2005
- Last updated
- Aug 13, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 32337 | AZ | Primary |
Addresses
Primary practice location
3345 N Windsong Dr
Windsong Center
Prescott Valley, AZ 86314-2283
Mailing address
642 Dameron Dr
Prescott, AZ 86301-2411
Phone (928) 445-5211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 18, 2023 through Jan 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32337 | AZ | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344816000000",
"number": "1639169154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "642 DAMERON DR",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863012411",
"telephone_number": "928-445-5211",
"fax_number": "928-776-8484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3345 N WINDSONG DR",
"address_2": "WINDSONG CENTER",
"city": "PRESCOTT VALLEY",
"state": "AZ",
"postal_code": "863142283",
"telephone_number": "928-445-5211",
"fax_number": "928-776-8484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALDERAS",
"first_name": "RAQUEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-26",
"last_updated": "2012-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AZ",
"license": "32337",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott Valley, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.