Provider Demographics
NPI:1205557550
Name:BALLESTEROS, LEIA MICHELLE DUMLAO (OD)
Entity type:Individual
Prefix:DR
First Name:LEIA
Middle Name:MICHELLE DUMLAO
Last Name:BALLESTEROS
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:910 E STOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7001
Mailing Address - Country:US
Mailing Address - Phone:805-925-2637
Mailing Address - Fax:805-925-3617
Practice Address - Street 1:590 HARBOR ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1904
Practice Address - Country:US
Practice Address - Phone:805-772-1269
Practice Address - Fax:805-772-2172
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA35259152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist