Provider Demographics
NPI:1811007412
Name:BALLESTER-FIALLO, ANA MIRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:MIRIAM
Last Name:BALLESTER-FIALLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:BALLESTER PINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:720 PLEASANTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1306
Mailing Address - Country:US
Mailing Address - Phone:210-921-3800
Mailing Address - Fax:210-334-2851
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:STE. 170
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-921-3800
Practice Address - Fax:210-334-2851
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3647207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH3647OtherLICENCE
TXF41504Medicare UPIN
TX309416YKQQMedicare PIN
TXPOOOJ23U6Medicaid