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General NPI Number Information
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NPI Number | 1598057473
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Entity Type | Individual
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Provider Name | CYNTHIA LAVERTY BALLESTEROS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 3751 S I 35 E
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City | DENTON
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State | TX
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Zip | 76210-6852
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Country | US
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Telephone | 940-383-2700
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Fax | 940-383-7640
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Provider Business Mailing Address
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Address Line | PO BOX 9101
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City | COPPELL
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State | TX
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Zip | 75019-9494
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Country | US
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Telephone | 940-383-2700
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Fax | 940-383-7640
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01081615A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2019-00095
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101266203
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | Q3223
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License Number State | TX
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