Provider Demographics
NPI:1073372884
Name:RAMIREZ DE BALLESTEROS, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:RAMIREZ DE BALLESTEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7622
Mailing Address - Country:US
Mailing Address - Phone:208-590-0771
Mailing Address - Fax:
Practice Address - Street 1:617 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7622
Practice Address - Country:US
Practice Address - Phone:208-590-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider