Provider Demographics
NPI:1952039216
Name:BALLI, JOSLYN RAE
Entity Type:Individual
Prefix:
First Name:JOSLYN
Middle Name:RAE
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 1:1720 GRAND AVENUE PKWY APT 7201
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2086
Mailing Address - Country:US
Mailing Address - Phone:956-970-2064
Mailing Address - Fax:
Practice Address - Street 1:200 BOBCAT WAY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8033
Practice Address - Country:US
Practice Address - Phone:512-716-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program