Provider Demographics
NPI:1902458250
Name:ORTEGA BALASQUIDE, JAVIER ALFONSO (MD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:ALFONSO
Last Name:ORTEGA BALASQUIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 N SAN SABA STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3164
Mailing Address - Country:US
Mailing Address - Phone:210-212-8622
Mailing Address - Fax:210-212-9197
Practice Address - Street 1:215 N SAN SABA STE 301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3164
Practice Address - Country:US
Practice Address - Phone:210-212-8622
Practice Address - Fax:210-212-9197
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5189207R00000X, 207RN0300X
PR35728R390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology