Miriam Sara Ballejos, PHD, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DI60224467 Issued in WA

Practice address

9040A Jackson Ave
Tacoma, WA 98431

Phone

(253) 968-0547

NPI assigned

Dec 10, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miriam Sara Edlefsen Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589846400000",
    "number": "1336484864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040A JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-0547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040A JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98431",
            "telephone_number": "253-968-0547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLEJOS",
        "first_name": "MIRIAM",
        "middle_name": "SARA",
        "credential": "PHD, RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-10",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI60224467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "miriam.s.ballejos.civ@mail.mil",
            "affiliation": "N",
            "address_1": "9040A Jackson Ave",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "98431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MIRIAM",
            "last_name": "EDLEFSEN",
            "middle_name": "SARA",
            "credential": "PHD, RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Alice Ball, OTR
• Morgan Tyler Ball, D.M.D
• Vincent Lee Ball, M.D.
• Lacey Camille Ballard, CNM
• Robin Ballard, DH
• Mary E. Baller
• Emily Ballew
• Grecel Palmes Balleza
• Berta Balli, MSW, LCSW
• Noelle Elizabeth Balliett, PH.D.

• Registered Dietitian in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Registered Dietitian in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.