Basic Information
| Provider Information | |||||||||
| NPI: | 1861645525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLESTAS | ||||||||
| FirstName: | EDUARDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3165 SPOONBILL CT. | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274224063 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1850 NW 9TH AVE | ||||||||
| Address2: | RYDER TRAUMA T242 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055851280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2008 | ||||||||
| LastUpdateDate: | 10/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME 117835 | FL | Y | Other Service Providers | Specialist | 390200000X | TRN10743 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.