| Doctor Name: | DR. EDWIN BALLELOS |
| NPI Number: | 1184679151 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME0076442 |
| Business Practice Address: | 4101 Town Ctr Blvd Orlando, FL - 328375846 |
| Business Phone Number: | 4078503497 |
| Business Fax Number: | 4078510421 |
| Mailing Address: | Po Box 191, ROCKLAND |
| State: | DE |
| Postal Code: | 197320191 |
| Phone Number: | 3026514488 |
| Fax Number: | 3026514945 |
| NPI Enumeration Date: | 05/24/2006 |
| NPI Last Update Date: | 02/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | ME0076442 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |