Provider Demographics
NPI:1376975672
Name:BALLARIN, DANIEL (CPO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BALLARIN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2209
Mailing Address - Country:US
Mailing Address - Phone:415-861-4146
Mailing Address - Fax:415-861-0653
Practice Address - Street 1:330 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2209
Practice Address - Country:US
Practice Address - Phone:415-861-4146
Practice Address - Fax:415-861-0653
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist