Individual
JAY A BALESTRIERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
400 W 17TH ST, PUEBLO, CO 81003-2649
(719) 296-6872
(719) 583-0688
Mailing address
1235 N BLAZING TRAIL DR, PUEBLO WEST, CO 81007-3934
(719) 251-2071
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
109032
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69325561
—
CO
Enumeration date
02/13/2007
Last updated
11/14/2007
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