Provider Demographics
NPI:1063991370
Name:BALLI, SWETHA
Entity type:Individual
Prefix:
First Name:SWETHA
Middle Name:
Last Name:BALLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 E HOME AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2027
Mailing Address - Country:US
Mailing Address - Phone:559-457-6900
Mailing Address - Fax:559-400-8432
Practice Address - Street 1:1105 E SPRUCE AVE STE 201
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3313
Practice Address - Country:US
Practice Address - Phone:559-450-2630
Practice Address - Fax:559-450-0351
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA174790207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program