Provider Demographics
NPI:1811372055
Name:BALANCE WITHIN - AN INTEGRATIVE ACUPUNCTURE CORP.
Entity Type:Organization
Organization Name:BALANCE WITHIN - AN INTEGRATIVE ACUPUNCTURE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:EZZATI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-478-9401
Mailing Address - Street 1:16200 VENTURA BLVD STE 409
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4699
Mailing Address - Country:US
Mailing Address - Phone:818-478-9401
Mailing Address - Fax:818-478-9411
Practice Address - Street 1:16200 VENTURA BLVD STE 409
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4699
Practice Address - Country:US
Practice Address - Phone:818-478-9401
Practice Address - Fax:818-478-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14696305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service