Provider Demographics
NPI:1518650340
Name:BALANCE AND BLOSSOM NUTRITION LLC
Entity Type:Organization
Organization Name:BALANCE AND BLOSSOM NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACIE
Authorized Official - Middle Name:ADELE
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:786-973-1918
Mailing Address - Street 1:11331 SW 9TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4306
Mailing Address - Country:US
Mailing Address - Phone:786-973-1918
Mailing Address - Fax:
Practice Address - Street 1:11331 SW 9TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4306
Practice Address - Country:US
Practice Address - Phone:786-973-1918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty