Provider Demographics
NPI:1740688258
Name:BALANCED NUTRITION LLC
Entity type:Organization
Organization Name:BALANCED NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:520-730-3094
Mailing Address - Street 1:3447 E CORTE PALOMA BRAVA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3454
Mailing Address - Country:US
Mailing Address - Phone:520-730-3094
Mailing Address - Fax:520-428-5812
Practice Address - Street 1:7493 N ORACLE RD STE 203
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6332
Practice Address - Country:US
Practice Address - Phone:520-730-3094
Practice Address - Fax:520-428-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service