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General NPI Number Information
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NPI Number | 1841447950
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Entity Type | Individual
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Provider Name | BROOKE LAURA BALLARD M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 277 RANCHEROS DR STE 101
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City | SAN MARCOS
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State | CA
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Zip | 92069-2976
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Country | US
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Telephone | 760-750-1902
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Fax | 760-750-1906
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Provider Business Mailing Address
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Address Line | 277 RANCHEROS DR STE 101
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City | SAN MARCOS
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State | CA
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Zip | 92069-2976
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Country | US
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Telephone | 760-750-1902
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Fax | 760-750-1906
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A104161
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | TRN#17204
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License Number State | FL
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