Healthcare Provider Details

I. General information

NPI: 1477853281
Provider Name (Legal Business Name): ALBERTINA BALLESTERO LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E MINARETS AVE
PINEDALE CA
93650-1239
US

IV. Provider business mailing address

40 E. MINARETS
PINEDALE CA
93650-2109
US

V. Phone/Fax

Practice location:
  • Phone: 559-316-9957
  • Fax:
Mailing address:
  • Phone: 559-316-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number237653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: