Healthcare Provider Details

I. General information

NPI: 1073216982
Provider Name (Legal Business Name): BERENITZE BALLADARES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8989 WINTON RD STE 100
CINCINNATI OH
45231-3817
US

IV. Provider business mailing address

2139 AUBURN AVENUE ATTN: PAYOR ENROLLMENT 4-7
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-679-4866
  • Fax: 513-761-2776
Mailing address:
  • Phone: 513-351-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.156605
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: