Provider Demographics
NPI:1881643914
Name:BALA, PADMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMA
Middle Name:
Last Name:BALA
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 1:1650 REPUBLIC PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6916
Mailing Address - Country:US
Mailing Address - Phone:972-682-4100
Mailing Address - Fax:972-270-9637
Practice Address - Street 1:7345 MEDICAL CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1963
Practice Address - Country:US
Practice Address - Phone:818-883-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7779208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0436370-01Medicaid
TX370010633OtherRR MEDICARE
TXF21434Medicare UPIN
TX0436370-01Medicaid