OrganizationDavid S Ballestas Md Pa(<Unavail>)SpecialistOther Service ProvidersPractice Address2525 Harbor Blvd, Suite 102, Port Charlotte, FL 33952-5317(941) 629-7593PECOS EnrollmentBased on the most recent information from CMS, provider David S Ballestas Md Pa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1093901282Provider TypeOrganizationFull NameDavid S Ballestas Md PaOther Name<Unavail>SubpartNoEnumeration Date9/20/2007Last Updated5/9/2008Contact InformationPractice LocationPractice Address2525 Harbor Blvd, Suite 102, Port Charlotte, FL 33952-5317Phone(941) 629-7593Fax(941) 625-2751Mailing LocationMailing Address2525 Harbor Blvd, Suite 102, Port Charlotte, FL 33952-5317Phone(941) 629-7593Fax(941) 625-2751Authorized OfficialNameBallestas, David S. (Owner/President)Phone(941) 629-7593Provider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicenseH87694FloridaProvider IdentifiersIDDescriptionIssuerID40389DescriptionOtherIssuerMEDICARE GROUP NUMBERFlorida