NICOLETTE LEE BALLOU MD NPI 1457420077

NPI Information

  • NPI: 1457420077
  • Provider Name: NICOLETTE LEE BALLOU, MD
  • Classification: Pediatrics - 208000000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • CLIA Number: 05D2314106
  • Address: 8920 WILSHIRE BLVD
    STE 604
    BEVERLY HILLS, CA
    ZIP 90211
  • Phone: (310) 659-7867

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NPI Details

Nicolette Lee Ballou, MD is a pediatrics in Beverly Hills, CA with 44 years of experience. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. Nicolette Lee Ballou, MD NPI is 1457420077. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: HOWARD UNIVERSITY COLLEGE OF MEDICINE
Graduation Year:1981

The provider's business location address is:

8920 WILSHIRE BLVD
STE 604
BEVERLY HILLS, CA
ZIP 90211
Phone: (310) 659-7867
Fax: (310) 659-0804

The NPI 1457420077 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The CLIA number assigned to this NPI record is 05D2314106 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/7/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsG53313CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100G53313MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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