Provider Demographics
NPI:1477001220
Name:BALLESTEROS-ANDRADE, LUZ H
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:H
Last Name:BALLESTEROS-ANDRADE
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 1:3075 FLAGLER AVE UNIT 14
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4098
Mailing Address - Country:US
Mailing Address - Phone:305-393-6195
Mailing Address - Fax:
Practice Address - Street 1:1111 12TH STREET SUITE 102
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4098
Practice Address - Country:US
Practice Address - Phone:305-393-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker