Provider Demographics
NPI:1952738676
Name:B BALANCED INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:B BALANCED INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-305-2757
Mailing Address - Street 1:12039 SW 132ND CT UNIT 28-5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4785
Mailing Address - Country:US
Mailing Address - Phone:305-305-2757
Mailing Address - Fax:305-385-1675
Practice Address - Street 1:12039 SW 132ND CT UNIT 28-5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4785
Practice Address - Country:US
Practice Address - Phone:305-305-2757
Practice Address - Fax:305-385-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10569261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service