Provider Demographics
NPI:1851815039
Name:BALLESTEROS OLIVA, CRISTHIAN
Entity Type:Individual
Prefix:
First Name:CRISTHIAN
Middle Name:
Last Name:BALLESTEROS OLIVA
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 1:14138 SW 160TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6503
Mailing Address - Country:US
Mailing Address - Phone:786-320-1492
Mailing Address - Fax:
Practice Address - Street 1:14138 SW 160TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-6503
Practice Address - Country:US
Practice Address - Phone:786-320-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician