Healthcare Provider Details

I. General information

NPI: 1063991370
Provider Name (Legal Business Name): SWETHA BALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 E SPRUCE AVE STE 201
FRESNO CA
93720-3313
US

IV. Provider business mailing address

1685 E HOME AVE
FRESNO CA
93728-2027
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-2630
  • Fax: 559-450-0351
Mailing address:
  • Phone: 559-457-6900
  • Fax: 559-400-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA174790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: