MEDICARE: BALANCENTER WELLNESS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1225635386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCENTER WELLNESS INC

Provider Business Mailing Address
First Line	:	3225 MCLEOD DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 MAIN ST FL 2
Second Line	:
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-1722
Country	:	US
Telephone Number	:	650-333-1433
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	SUSAN MOLINA
Credential	:
Telephone Number	:	949-836-7698

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/01/2020

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Directions to “BALANCENTER WELLNESS INC ” Practice Location

Language	Start Address	Practice Location

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