Provider Demographics
NPI:1316929615
Name:BALLOCH, JODY LYNN (MD)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNN
Last Name:BALLOCH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3400 DATA DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-379-2915
Mailing Address - Fax:916-853-7794
Practice Address - Street 1:5051 VERDUGO WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012
Practice Address - Country:US
Practice Address - Phone:805-384-8071
Practice Address - Fax:805-987-1927
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2014-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAGO77362207Q00000X
CAG77362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG02215Medicare UPIN
CAWG77362BMedicare PIN