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NPI Code Detail

MEDICARE: ANAISYS M. BALLESTEROS, D.O., P.A.

MEDICARE: ANAISYS M. BALLESTEROS, D.O., P.A.
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
1207Q00000XFamily Medicine PhysicianOS8354FL

General Provider Information

NPI Number : 1750488326
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANAISYS M. BALLESTEROS, D.O., P.A.
Provider Business Mailing Address
First Line : 9290 SW 72ND ST
Second Line : SUITE 105
City : MIAMI
State : FL
Zip : 33173-3236
Country : US
Telephone Number : 305-275-6202
Fax Number : 305-275-6203
Provider Business Practice Location Address
First Line : 9290 SW 72ND ST
Second Line : SUITE 105
City : MIAMI
State : FL
Zip : 33173-3236
Country : US
Telephone Number : 305-275-6202
Fax Number : 305-275-6203
Authorized Official
Title or Position : PRESIDENT
Name : DR. ANAISYS MARIA BALLESTEROS
Credential : D.O.
Telephone Number : 305-275-6202
Provider Enumeration Date : 09/17/2006
Last Update Date : 08/22/2020

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