Provider Demographics
NPI:1912384686
Name:BALLESTEROS, CARLOS EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:EDUARDO
Last Name:BALLESTEROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 N RAUL LONGORIA RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3714
Mailing Address - Country:US
Mailing Address - Phone:956-782-7878
Mailing Address - Fax:956-782-7877
Practice Address - Street 1:1211 N RAUL LONGORIA RD STE C
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3714
Practice Address - Country:US
Practice Address - Phone:956-782-7878
Practice Address - Fax:956-782-7877
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4097207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology