Provider Demographics
NPI:1093403347
Name:BALISTRERI, ILENIA
Entity Type:Individual
Prefix:
First Name:ILENIA
Middle Name:
Last Name:BALISTRERI
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 1:80 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7303
Mailing Address - Country:US
Mailing Address - Phone:408-351-6400
Mailing Address - Fax:
Practice Address - Street 1:5632 SANTA TERESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2633
Practice Address - Country:US
Practice Address - Phone:408-351-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator