Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 286 | NM |
NPI | 1063418556 |
---|---|
Provider Name | Shanti Balkissoon-Castillo |
First Address | Albuquerque, NM 87110-4639 |
Second Address | Albuquerque, NM 87110-4639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 30/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
77777 | PRESBYTERIAN HEALTH PLAN (01) | NM |
79774059 | (05) | NM |
NM005433 | BLUE CROSS BLUE SHIELD (01) | NM |
U72531 | (02) | NM |