Provider Demographics
NPI:1780669838
Name:RONALDO A BALLECER MD INC
Entity Type:Organization
Organization Name:RONALDO A BALLECER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALLECER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-432-5154
Mailing Address - Street 1:540 E HERNDON AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2907
Mailing Address - Country:US
Mailing Address - Phone:559-432-5154
Mailing Address - Fax:559-432-8763
Practice Address - Street 1:540 E HERNDON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2907
Practice Address - Country:US
Practice Address - Phone:559-432-5154
Practice Address - Fax:559-432-8763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34864207Y00000X, 207YX0007X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A348641Medicaid
CA00A348641Medicaid
CAZZZ029382Medicare ID - Type Unspecified