Provider Demographics
NPI:1033367016
Name:GONZALEZ BALLESTEROS, LUISA FERNANDA LORENA EDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:LUISA FERNANDA
Middle Name:LORENA EDITH
Last Name:GONZALEZ BALLESTEROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LUISA
Other - Middle Name:FERNANDA
Other - Last Name:GONZALEZ BALLESTEROS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:130 E 77TH ST
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1851
Mailing Address - Country:US
Mailing Address - Phone:212-434-2135
Mailing Address - Fax:
Practice Address - Street 1:130 E 77TH ST
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS, LENOX HILL HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1851
Practice Address - Country:US
Practice Address - Phone:212-434-2135
Practice Address - Fax:212-434-3374
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2628522080P0205X, 2080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine