Individual
KYLA BALLESTEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1250 S CLEARVIEW AVE, SUITE 100, MESA, AZ 85209-3378
(480) 988-9108
(480) 813-4460
Mailing address
3611 N CAMPBELL AVE, TUCSON, AZ 85719-1534
(520) 881-0636
(520) 881-0637
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4886
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
668590
—
AZ
Enumeration date
05/28/2009
Last updated
12/02/2014
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