Provider Demographics
NPI:1427356617
Name:ABSOLUTE BALANCE OF LIFE HEALTH AND WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:ABSOLUTE BALANCE OF LIFE HEALTH AND WELLNESS CENTER, INC.
Other - Org Name:BRAZELIA MED SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRAZELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZARI
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:561-353-2265
Mailing Address - Street 1:2561 NW 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8156
Mailing Address - Country:US
Mailing Address - Phone:561-353-2265
Mailing Address - Fax:561-353-2267
Practice Address - Street 1:101 PLAZA REAL S
Practice Address - Street 2:SUITE G.
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-4837
Practice Address - Country:US
Practice Address - Phone:561-353-2265
Practice Address - Fax:561-353-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2366171100000X
FLME36889208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty