Individual
JUAN R BALLESTEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
160 E ERIE AVE, PHILADELPHIA, PA 19134-1011
(215) 427-5202
Mailing address
PO BOX 13579, READING, PA 19612-3579
(484) 628-1324
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
MD055998L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001759708
—
PA
05
—
0017597080005
—
PA
Enumeration date
10/13/2005
Last updated
02/08/2024
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