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NPI Code Detail

MEDICARE: MISS MIKAELA BALL

MEDICARE: MISS MIKAELA BALL
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1912576182
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MIKAELA BALL
Provider Business Mailing Address
First Line : 4946 PLEASANT VALLEY RD PO BOX 925
Second Line :
City : DIAMOND SPRINGS
State : CA
Zip : 95619
Country : US
Telephone Number : 530-957-1366
Fax Number :
Provider Business Practice Location Address
First Line : 4980 HILLSDALE CIR
Second Line :
City : EL DORADO HILLS
State : CA
Zip : 95762-5726
Country : US
Telephone Number : 916-693-6469
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2021
Last Update Date : 06/22/2021

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Directions to “ MISS MIKAELA BALL ” Practice Location

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