Provider Demographics
NPI:1164649554
Name:BALLESTER, MARIA ELISA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELISA
Last Name:BALLESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8936
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0936
Mailing Address - Country:US
Mailing Address - Phone:787-725-2222
Mailing Address - Fax:787-725-4450
Practice Address - Street 1:1449 CALLE AMERICO SALAS
Practice Address - Street 2:EDIFICIO PAVIA II SUITE 101
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2100
Practice Address - Country:US
Practice Address - Phone:787-725-2222
Practice Address - Fax:787-725-4450
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR98392081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE59287Medicare UPIN
PR81981Medicare ID - Type Unspecified