Provider Demographics
NPI:1841521069
Name:BALLESTAS, JULIO (MD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:
Last Name:BALLESTAS
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 1:200 S PARK RD STE 140
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8351
Mailing Address - Country:US
Mailing Address - Phone:631-260-7360
Mailing Address - Fax:
Practice Address - Street 1:200 S PARK RD STE 140
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8351
Practice Address - Country:US
Practice Address - Phone:631-260-7360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1424362084P0800X
VA01012837902084P0800X
NY2749232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry