Provider Demographics
NPI:1114222353
Name:BALLESTEROS, NOELIA LIZETH
Entity Type:Individual
Prefix:
First Name:NOELIA
Middle Name:LIZETH
Last Name: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 1:12440 FIRESTONE BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4382
Mailing Address - Country:US
Mailing Address - Phone:562-929-4378
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD STE 215
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4382
Practice Address - Country:US
Practice Address - Phone:562-929-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner