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General NPI Number Information
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NPI Number | 1316929615
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Entity Type | Individual
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Provider Name | JODY LYNN BALLOCH MD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 5051 VERDUGO WAY SUITE 110
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City | CAMARILLO
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State | CA
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Zip | 93012
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Country | US
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Telephone | 805-384-8071
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Fax | 805-987-1927
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Provider Business Mailing Address
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Address Line | 3400 DATA DRIVE
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone | 916-379-2915
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Fax | 916-853-7794
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | GO77362
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G77362
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License Number State | CA
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