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Organization

NICOLLETTE L. BALLOU, M.D.

Active
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Organization

NICOLLETTE L. BALLOU, M.D.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NICOLETTE LEE BALLOU MD (CEO)
(310) 659-7867
Entity
Organization

Contact information

Practice address
3831 HUGHES AVE STE 602, CULVER CITY, CA 90232-6845
(310) 659-7867
(310) 878-2118
Mailing address
3831 HUGHES AVE STE 602, CULVER CITY, CA 90232-6845
(310) 659-7867
(310) 878-2118

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457420077
—
CA
Enumeration date
04/09/2020
Last updated
04/09/2020
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