Individual
BOBBY BALLESTEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14614 S BROUGHAM DR, OLATHE, KS 66062-2595
(913) 961-2306
Mailing address
14614 S BROUGHAM DR, OLATHE, KS 66062-2595
(913) 961-2306
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
332B00000X
—
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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