Provider Demographics
NPI:1407970213
Name:BALLESTEROS, MARY ANN OCAMPO (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:OCAMPO
Last Name:BALLESTEROS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5264 MILL CREEK LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-3611
Mailing Address - Country:US
Mailing Address - Phone:408-202-6371
Mailing Address - Fax:
Practice Address - Street 1:5264 MILL CREEK LN
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-3611
Practice Address - Country:US
Practice Address - Phone:408-202-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics