Provider Demographics
NPI:1194941641
Name:BALLECER, RONALDO A (MD)
Entity type:Individual
Prefix:MR
First Name:RONALDO
Middle Name:A
Last Name:BALLECER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:RONALDO
Other - Middle Name:A
Other - Last Name:BALLECER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:540 EAST HERNDON AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:FRENSO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2993
Mailing Address - Country:US
Mailing Address - Phone:559-432-5154
Mailing Address - Fax:559-432-8763
Practice Address - Street 1:540 E HERNDON AVE STE 105
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2993
Practice Address - Country:US
Practice Address - Phone:559-432-5154
Practice Address - Fax:559-432-8763
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34864207YX0007X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100870Medicaid
CAZZZ02938ZMedicare ID - Type Unspecified
CA00A348641Medicare PIN
A27610Medicare UPIN