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Individual

MRS. KATHARINE J BALBUENA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1111 LINE AVE, SHREVEPORT, LA 71101-3841
(817) 284-9850
(817) 284-9859
Mailing address
PO BOX 734107, DALLAS, TX 75373-4107
(817) 284-9850
(817) 284-3425

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
K0624
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0030QD
BCBS
TX
05
029577601
TX
01
8AJ344
BCBS
TX
Enumeration date
03/22/2006
Last updated
03/28/2025
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