Organization
BALLAST MEDICAL MANAGEMENT, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OMAR MONTESINO JR. (CHIEF EXECUTIVE OFFICER)
(786) 615-2572
Entity
Organization
Contact information
Practice address
9200 S DADELAND BLVD STE 208, MIAMI, FL 33156-2707
(786) 326-2830
Mailing address
9200 S DADELAND BLVD STE 208, MIAMI, FL 33156-2707
(786) 326-2830
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
01/12/2018
Last updated
11/14/2023
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