Provider Demographics
NPI:1982821419
Name:BALLESTER-SOSA, BLANCA M (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:M
Last Name:BALLESTER-SOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 CALLE SANTA NARCISA
Mailing Address - Street 2:EXT COLLEGE PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4714
Mailing Address - Country:US
Mailing Address - Phone:787-758-9334
Mailing Address - Fax:
Practice Address - Street 1:286 CALLE UPSALA
Practice Address - Street 2:EXT COLLEGE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4838
Practice Address - Country:US
Practice Address - Phone:787-763-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11104174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist