Provider Demographics
NPI:1750488326
Name:ANAISYS M. BALLESTEROS, D.O., P.A.
Entity Type:Organization
Organization Name:ANAISYS M. BALLESTEROS, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAISYS
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BALLESTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-275-6202
Mailing Address - Street 1:9290 SW 72ND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3236
Mailing Address - Country:US
Mailing Address - Phone:305-275-6202
Mailing Address - Fax:305-275-6203
Practice Address - Street 1:9290 SW 72ND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3236
Practice Address - Country:US
Practice Address - Phone:305-275-6202
Practice Address - Fax:305-275-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH63657Medicare UPIN