Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1760847289 |
---|---|
Provider Name | Ximena Ballesteros |
First Address | Orlando, FL 32835-6687 |
Second Address | Orlando, FL 32835-6687 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2015 |
Last Update Date | 29/12/2015 |