Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A34864 | CA |
NPI | 1194941641 |
---|---|
Provider Name | Mr. Ronaldo A Ballecer |
First Address | Frenso, CA 93720-2993 |
Second Address | Fresno, CA 93720-2993 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 27/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A27610 | (02) | |
GR0100870 | (05) | CA |