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General NPI Number Information
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NPI Number | 1508897216
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Entity Type | Individual
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Provider Name | MARTHA BALLESTEROS MD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 3100 SW 62ND AVE RADIOLOGY DEPARTMENT
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City | MIAMI
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State | FL
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Zip | 33155
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Country | US
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Telephone | 305-662-8392
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Fax | 305-667-8689
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Provider Business Mailing Address
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Address Line | 3100 SW 62ND AVE RADIOLOGY DEPARTMENT
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City | MIAMI
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State | FL
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Zip | 33155-3009
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Country | US
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Telephone | 305-662-8392
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Fax | 305-667-8689
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 60960
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 60960
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | ME71982
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License Number State | FL
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