| Doctor Name: | DR. ROBERTO ALEJANDRO BALLIVIAN |
| NPI Number: | 1386958791 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | N6158 |
| Business Practice Address: | 2411 Fountain View Dr Ste. 200 Houston, TX - 770574817 |
| Business Phone Number: | 7136204000 |
| Business Fax Number: | |
| Mailing Address: | Po Box 650865, DALLAS |
| State: | TX |
| Postal Code: | 752650865 |
| Phone Number: | 7136204000 |
| Fax Number: | |
| NPI Enumeration Date: | 07/28/2010 |
| NPI Last Update Date: | 07/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | N6158 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |