Individual
DR. FABIAN A MENDOZA BALLESTEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
211 S 9TH ST, SUITE 600, PHILADELPHIA, PA 19107-6810
(215) 955-8430
(215) 923-5828
Mailing address
211 S 9TH ST, SUITE 600, PHILADELPHIA, PA 19107-6810
(215) 955-8430
(215) 923-5828
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
003041
NY
207RR0500X
Rheumatology Physician
Primary
MD436636
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0197271
—
NJ
05
—
102331909
—
PA
Enumeration date
05/20/2008
Last updated
11/20/2014
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