Provider Demographics
NPI:1568899375
Name:BALLESTEROS, ANGELA (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BALLESTEROS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4148
Mailing Address - Country:US
Mailing Address - Phone:707-704-7553
Mailing Address - Fax:
Practice Address - Street 1:212 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-4148
Practice Address - Country:US
Practice Address - Phone:707-704-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA849348163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse