Individual
DANIEL T CEBALLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGNP
Contact information
Practice address
12655 OLIVE BLVD FL 4, SAINT LOUIS, MO 63141-6291
(314) 394-7444
(314) 627-8957
Mailing address
PO BOX 410770, SAINT LOUIS, MO 63141-0770
(314) 851-1000
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2024026725
MO
363LG0600X
Gerontology Nurse Practitioner
2024026725
MO
Other
Enumeration date
08/01/2024
Last updated
08/01/2024
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