Individual
JOSEFINO CEBALLOS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2300 OPITZ BLVD, WOODBRIDGE, VA 22191-3311
(703) 670-1313
(904) 346-0113
Mailing address
PO BOX 75567, BALTIMORE, MD 21275-5567
(703) 205-9790
(904) 346-0113
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101022025
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001
BCBS
VA
05
—
5833795
—
VA
Enumeration date
05/26/2006
Last updated
07/08/2007
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