Doctor Name: | MRS. LETICIA H BALLESTEROS |
NPI Number: | 1518235852 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 646685 |
Business Practice Address: | 308 S Cesar Chavez Ave Crystal City, TX - 788394200 |
Business Phone Number: | 8303742301 |
Business Fax Number: | 8303749368 |
Mailing Address: | 308 S Cesar Chavez Ave, CRYSTAL CITY |
State: | TX |
Postal Code: | 788394200 |
Phone Number: | 8303742301 |
Fax Number: | 8303749368 |
NPI Enumeration Date: | 12/01/2011 |
NPI Last Update Date: | 01/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 646685 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |