Provider Demographics
NPI:1649225111
Name:BALLANI, PIYA LILO (MD)
Entity Type:Individual
Prefix:DR
First Name:PIYA
Middle Name:LILO
Last Name:BALLANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W. ROMNEYA DRIVE
Mailing Address - Street 2:103
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-535-0000
Mailing Address - Fax:714-535-3055
Practice Address - Street 1:1801 W. ROMNEYA DRIVE
Practice Address - Street 2:103
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-535-0000
Practice Address - Fax:714-535-3055
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85083174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist