Basic Information
| Provider Information | |||||||||
| NPI: | 1316929615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLOCH | ||||||||
| FirstName: | JODY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DRIVE | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163792915 | ||||||||
| FaxNumber: | 9168537794 | ||||||||
| Practice Location | |||||||||
| Address1: | 5051 VERDUGO WAY | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053848071 | ||||||||
| FaxNumber: | 8059871927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | GO77362 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | G77362 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.