Individual
DR. CARLOS ENRIQUE BALLESTAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12651 W SUNRISE BLVD STE 202, SUNRISE, FL 33323-0906
(954) 838-8801
(954) 838-8807
Mailing address
12651 W SUNRISE BLVD STE 202, SUNRISE, FL 33323-0906
(954) 838-8801
(954) 838-8807
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
M2549
TX
207Q00000X
Family Medicine Physician
Primary
ME110974
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1791238-02
—
TX
Enumeration date
06/21/2006
Last updated
02/10/2022
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