1962780825 NPI number — FRANK BALLESTEROS

Table of content: MRS. SHAINA DALEY ELLIS LMT (NPI 1811751134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962780825 NPI number — FRANK BALLESTEROS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANK BALLESTEROS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TEXAS HEARING AID SPECIALIST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962780825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3505 CRESTDALE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78415-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-947-3590
Provider Business Mailing Address Fax Number:
361-854-0026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3921 SARATOGA BLVD
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78415-5819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-947-3590
Provider Business Practice Location Address Fax Number:
361-854-0026
Provider Enumeration Date:
07/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BALLESTEROS
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
361-947-3590

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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