Provider Demographics
NPI:1558979344
Name:BALLESTEROS-YEFREMOV, JANNIE
Entity Type:Individual
Prefix:
First Name:JANNIE
Middle Name:
Last Name:BALLESTEROS-YEFREMOV
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 1:2030 S OCEAN DR APT 2111
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6616
Mailing Address - Country:US
Mailing Address - Phone:954-560-2055
Mailing Address - Fax:
Practice Address - Street 1:2030 S OCEAN DR APT 2111
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6616
Practice Address - Country:US
Practice Address - Phone:954-560-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist