Provider Demographics
NPI:1124368030
Name:BALLESTEROS, CLAUDIA (ASSOCIATES, BACHL)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:
Last Name:BALLESTEROS
Suffix:
Gender:F
Credentials:ASSOCIATES, BACHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5631 S RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2126
Mailing Address - Country:US
Mailing Address - Phone:773-546-8587
Mailing Address - Fax:
Practice Address - Street 1:5631 S. RICHMOND
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629
Practice Address - Country:US
Practice Address - Phone:773-546-8587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILB42310086649171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter