Healthcare Provider Details

I. General information

NPI: 1376975672
Provider Name (Legal Business Name): DANIEL BALLARIN CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 DIVISADERO ST
SAN FRANCISCO CA
94117-2209
US

IV. Provider business mailing address

330 DIVISADERO ST
SAN FRANCISCO CA
94117-2209
US

V. Phone/Fax

Practice location:
  • Phone: 415-861-4146
  • Fax: 415-861-0653
Mailing address:
  • Phone: 415-861-4146
  • Fax: 415-861-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: