Healthcare Provider Details

I. General information

NPI: 1780669838
Provider Name (Legal Business Name): RONALDO A BALLECER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E HERNDON AVE SUITE 105
FRESNO CA
93720-2907
US

IV. Provider business mailing address

540 E HERNDON AVE SUITE 105
FRESNO CA
93720-2907
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-5154
  • Fax: 559-432-8763
Mailing address:
  • Phone: 559-432-5154
  • Fax: 559-432-8763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA34864
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberA34864
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA34864
License Number StateCA

VIII. Authorized Official

Name: MR. RONALDO A BALLECER
Title or Position: OWNER
Credential: MD
Phone: 559-432-5154