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General NPI Number Information
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NPI Number | 1841521069
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Entity Type | Individual
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Provider Name | JULIO BALLESTAS M.D
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Gender | Male
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 200 S PARK RD STE 140
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8351
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Country | US
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Telephone | 631-260-7360
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S PARK RD STE 140
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8351
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Country | US
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Telephone | 631-260-7360
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME142436
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101283790
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 274923
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License Number State | NY
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