Individual
AUDRA BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3270 KERNER BLVD STE C, SAN RAFAEL, CA 94901-4840
(415) 457-4554
Mailing address
1917 KINROSS WAY, SAN JOSE, CA 95122-2943
(214) 797-7064
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/18/2024
Last updated
07/18/2024
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