Healthcare Provider Details

I. General information

NPI: 1174668271
Provider Name (Legal Business Name): ANAISYS M BALLESTEROS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8711 SW 192ND TER
CUTLER BAY FL
33157-8954
US

IV. Provider business mailing address

8711 SW 192ND TER
CUTLER BAY FL
33157-8954
US

V. Phone/Fax

Practice location:
  • Phone: 305-588-1833
  • Fax:
Mailing address:
  • Phone: 305-588-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8354
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: