Individual
MR. MARIO DEON BALLANTYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3945 ROSE OF SHARON DR, ORLANDO, FL 32808-2738
(321) 279-1218
(407) 704-4464
Mailing address
3945 ROSE OF SHARON DR, ORLANDO, FL 32808-2738
(321) 279-1218
(407) 704-4464
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
B453544754290
FL
347E00000X
Transportation Broker
Primary
B453544754290
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81-0683776
IRS
FL
Enumeration date
08/09/2017
Last updated
07/21/2022
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