Healthcare Provider Details

I. General information

NPI: 1245149020
Provider Name (Legal Business Name): BALLARD CA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 FULLERTON AVE
COSTA MESA CA
92627-2232
US

IV. Provider business mailing address

3267 BEE CAVES RD STE 107-225
AUSTIN TX
78746-6700
US

V. Phone/Fax

Practice location:
  • Phone: 833-216-0521
  • Fax:
Mailing address:
  • Phone: 833-216-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ARCE
Title or Position: COO
Credential:
Phone: 310-857-0115