Provider Demographics
NPI:1942927603
Name:BALLADARES, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BALLADARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11530 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3702
Mailing Address - Country:US
Mailing Address - Phone:305-975-1554
Mailing Address - Fax:
Practice Address - Street 1:9999 NE 2ND AVE STE 313
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2346
Practice Address - Country:US
Practice Address - Phone:305-771-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4244171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist