Individual
DORA EIKO MITSUE WATANABE BALLARTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
509 CAGAN VIEW RD, CLERMONT, FL 34714-6405
(407) 905-8827
(407) 905-8998
Mailing address
110 S WOODLAND ST, WINTER GARDEN, FL 34787-3546
(407) 905-8827
(407) 905-8998
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME147690
FL
390200000X
Student in an Organized Health Care Education/Training Program
31682-R
—
Other
Enumeration date
06/23/2015
Last updated
12/15/2020
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