MEDICARE: MISS MADDISON ELAINE BALLARD RD/RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86375177	CA

General Provider Information

NPI Number	:	1770422891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MADDISON ELAINE BALLARD RD/RDN

Provider Business Mailing Address
First Line	:	350 S OAKLAND AVE UNIT 208
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-4014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 S OAKLAND AVE UNIT 208
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-4014
Country	:	US
Telephone Number	:	480-316-5535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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