Provider Demographics
NPI:1710155940
Name:BALLARD, URSULA MICHELE (RD)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:MICHELE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 VIA SIERRA NEVADA
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6413
Mailing Address - Country:US
Mailing Address - Phone:951-369-3297
Mailing Address - Fax:
Practice Address - Street 1:772 VIA SIERRA NEVADA
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6413
Practice Address - Country:US
Practice Address - Phone:951-369-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered