Healthcare Provider Details

I. General information

NPI: 1710090816
Provider Name (Legal Business Name): TIMOTHY CROSS BALLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S FAIR OAKS AVE
PASADENA CA
91105-2603
US

IV. Provider business mailing address

5325 NEWCASTLE AVE UNIT 245
ENCINO CA
91316-3081
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-2244
  • Fax: 626-795-5378
Mailing address:
  • Phone: 818-708-7674
  • Fax: 818-708-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA94006
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA94006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: