Healthcare Provider Details

I. General information

NPI: 1962689455
Provider Name (Legal Business Name): KARLA PATRICIA BALLESTEROS F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

1228 CONEJO WAY
WALNUT CREEK CA
94597-2304
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-5200
  • Fax:
Mailing address:
  • Phone: 925-465-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number475610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: