Healthcare Provider Details

I. General information

NPI: 1629201744
Provider Name (Legal Business Name): BRONWYN E BALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 GAYLEY AVE SUITE 322
LOS ANGELES CA
90024-3423
US

IV. Provider business mailing address

1836 N NEW HAMPSHIRE AVE APT 202
LOS ANGELES CA
90027-4244
US

V. Phone/Fax

Practice location:
  • Phone: 310-208-4240
  • Fax:
Mailing address:
  • Phone: 440-315-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: