Basic Information
| Provider Information | |||||||||
| NPI: | 1508360587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLANCA | ||||||||
| FirstName: | ZERAHLYNN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2929 E THOMAS RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850168034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024705000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 950 E VAN BUREN ST | ||||||||
| Address2: | |||||||||
| City: | AVONDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853231506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233446800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2018 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 64114 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.