Provider Demographics
NPI:1235403494
Name:BALL, RANDIOLA (RN,PHN,MSN)
Entity Type:Individual
Prefix:
First Name:RANDIOLA
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:RN,PHN,MSN
Other - Prefix:
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN,PHN,MSN
Mailing Address - Street 1:1750 W CITRACADO PKWY
Mailing Address - Street 2:SPACE #4
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4100
Mailing Address - Country:US
Mailing Address - Phone:619-692-8830
Mailing Address - Fax:
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:STE:128 MS P576
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse