Provider Demographics
NPI:1992832984
Name:BALLER, JULIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:BALLER
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 1:1490 MASON ST
Mailing Address - Street 2:CHINATOWN PUBLIC HEALTH CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4222
Mailing Address - Country:US
Mailing Address - Phone:415-364-7600
Mailing Address - Fax:415-986-1130
Practice Address - Street 1:1490 MASON ST
Practice Address - Street 2:CHINATOWN PUBLIC HEALTH CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4222
Practice Address - Country:US
Practice Address - Phone:415-364-7600
Practice Address - Fax:415-986-1130
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31643207N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
021410OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
A44826Medicare UPIN