Provider Demographics
NPI:1659060275
Name:BALLESTEROS, JOSHUA LUKE
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LUKE
Last Name:BALLESTEROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 GATEWAY PL STE 526
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-3712
Mailing Address - Country:US
Mailing Address - Phone:408-444-2143
Mailing Address - Fax:
Practice Address - Street 1:2033 GATEWAY PL STE 526
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-3712
Practice Address - Country:US
Practice Address - Phone:669-205-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician