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ISSAC ROY BALLESTEROS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
101Y00000X

Contact information

Practice address
4200 S HULEN ST STE 436, FORT WORTH, TX 76109-4910
(817) 952-8180
Mailing address
4200 S HULEN ST STE 436, FORT WORTH, TX 76109-4910
(817) 952-8180

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
99657
TX

Other

Enumeration date
08/30/2021
Last updated
12/04/2025
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