Nicollette L. Ballou, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

NICOLLETTE L. BALLOU, M.D.

Practice address

3831 Hughes Ave Ste 602
Culver City, CA 90232-6845

Phone

(310) 659-7867

Fax

(310) 878-2118

NPI assigned

Apr 9, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicolette Lee Ballou, MD

Title

Ceo

Phone

(310) 659-7867

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586390400000",
    "number": "1790304707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3831 HUGHES AVE STE 602",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902326845",
            "telephone_number": "310-659-7867",
            "fax_number": "310-878-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3831 HUGHES AVE STE 602",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902326845",
            "telephone_number": "310-659-7867",
            "fax_number": "310-878-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLLETTE L. BALLOU, M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-09",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A",
        "authorized_official_last_name": "BALLOU",
        "authorized_official_first_name": "NICOLETTE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-659-7867",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457420077",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "littlestarsmd@aol.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3831 Hughes Ave Ste 602",
            "city": "Culver City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902326845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tonia Mailyn Nguyen
• Tristen Nguyen, D.D.S.
• Vivi Nguyen
• Grace Awah Ngwa
• Nickolas a Tomasic MD a Professional Corporation (Nickolas A Tomasic MD APC)
• Sophie Nikfarjam, M.A.
• Yoriko Nishi
• Jeffrey M Nishii, PSY.D.
• Daniela Nixon, RN
• Festia Nim Njokom

• Pediatrics Physician in Culver City, CA
• Providers in Culver City, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.