Provider Demographics
NPI:1689868150
Name:BALLESTER VARGAS, VEROUSHKA (MD)
Entity Type:Individual
Prefix:
First Name:VEROUSHKA
Middle Name:
Last Name:BALLESTER VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VEROUSHKA
Other - Middle Name:
Other - Last Name:BALLESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1510 AVE ASHFORD APT 802
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1173
Mailing Address - Country:US
Mailing Address - Phone:787-405-6141
Mailing Address - Fax:
Practice Address - Street 1:1431 AVE PONCE DE LEON STE 402
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4033
Practice Address - Country:US
Practice Address - Phone:787-723-9595
Practice Address - Fax:787-723-8051
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57366207RG0100X
NY280913207RG0100X
PR17946207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology