Provider Demographics
NPI:1558952937
Name:BALLI, ALEJANDRA DELIA
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:DELIA
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 1:15300 S IH 35 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610
Mailing Address - Country:US
Mailing Address - Phone:512-312-0907
Mailing Address - Fax:
Practice Address - Street 1:15300 S IH 35 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610
Practice Address - Country:US
Practice Address - Phone:512-312-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227539183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician