Provider Demographics
NPI:1700804531
Name:BACK TO BALANCE INC
Entity Type:Organization
Organization Name:BACK TO BALANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IZHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-260-7420
Mailing Address - Street 1:16161 VENTURA BLVD
Mailing Address - Street 2:STE 215
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-788-4513
Mailing Address - Fax:818-788-4523
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE
Practice Address - Street 2:2300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2424
Practice Address - Country:US
Practice Address - Phone:323-260-7420
Practice Address - Fax:323-260-7426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19695Medicare ID - Type Unspecified