MEDICARE: DR. MARIA ELISA BALLESTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081H0002X	Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician	9839	PR

General Provider Information

NPI Number	:	1164649554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA ELISA BALLESTER MD

Provider Business Mailing Address
First Line	:	PO BOX 8936
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-0936
Country	:	US
Telephone Number	:	787-725-2222
Fax Number	:	787-725-4450

Provider Business Practice Location Address
First Line	:	1449 CALLE AMERICO SALAS
Second Line	:	EDIFICIO PAVIA II SUITE 101
City	:	SANTURCE
State	:	PR
Zip	:	00909-2100
Country	:	US
Telephone Number	:	787-725-2222
Fax Number	:	787-725-4450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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