MEDICARE: JOSE VELOSO BALLESTEROS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	C52195	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770527269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE VELOSO BALLESTEROS M.D.

Provider Business Mailing Address
First Line	:	990 SONOMA AVE STE 2
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4813
Country	:	US
Telephone Number	:	707-636-8346
Fax Number	:	707-205-1008

Provider Business Practice Location Address
First Line	:	990 SONOMA AVE STE 2
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4813
Country	:	US
Telephone Number	:	707-636-8346
Fax Number	:	707-205-1008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	03/26/2026

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