Provider Demographics
NPI:1093249633
Name:IBALANCEME
Entity Type:Organization
Organization Name:IBALANCEME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-333-4366
Mailing Address - Street 1:300 N IRVING BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1508
Mailing Address - Country:US
Mailing Address - Phone:323-333-4366
Mailing Address - Fax:323-723-3967
Practice Address - Street 1:5544 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3924
Practice Address - Country:US
Practice Address - Phone:323-333-4366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15761261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service