Provider Demographics
NPI:1083332209
Name:QUANTUM BIOFEEDBACK BALANCE LLC
Entity Type:Organization
Organization Name:QUANTUM BIOFEEDBACK BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMENIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-819-2525
Mailing Address - Street 1:4999 W 8TH AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4999 W 8TH AVE STE 23
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3409
Practice Address - Country:US
Practice Address - Phone:305-819-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty